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General NPI Number Information
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NPI Number | 1750786158
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI DEPARTMENT HEALTH
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 1141 BAYVIEW AVE STE 102
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City | BILOXI
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State | MS
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Zip | 39530-1651
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Country | US
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Telephone | 228-436-6770
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Fax | 228-436-6781
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Provider Business Mailing Address
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Address Line | 1141 BAYVIEW AVE STE 102
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City | BILOXI
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State | MS
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Zip | 39530-1651
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Country | US
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Telephone | 228-436-6770
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Fax |
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Authorized Official
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Title or Position | DISTRICT HEALTH OFFICER
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Name | DR. D'ETTE EVELYN LORIO
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Credential | MD
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Telephone | 228-436-6770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 14132
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License Number State | MS
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