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General NPI Number Information
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NPI Number | 1841370749
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Entity Type | Organization
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Legal Business Name | MS STATE DEPT OF HELTH
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3128 8TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4753
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Country | US
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Telephone | 601-482-3171
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Fax |
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Provider Business Mailing Address
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Address Line | 769 CRANE RD
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City | CARTHAGE
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State | MS
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Zip | 39051-6110
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Country | US
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Telephone | 601-267-5027
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Fax |
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Authorized Official
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Title or Position | CLAMS ADJUSTER
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Name | MR. MARK PHILLIPS
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Credential |
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Telephone | 601-576-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | R505307
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License Number State | MS
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