=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841513280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUDSPETH REGIONAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2010
-----------------------------------------------------
Last Update Date | 03/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HIGHWAY 475 SOUTH
-----------------------------------------------------
City | WHITFIELD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39193-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-664-6000
-----------------------------------------------------
Fax | 601-354-6945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 127B
-----------------------------------------------------
City | WHITFIELD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39193-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-664-6000
-----------------------------------------------------
Fax | 601-354-6945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JOHN P. LIPSCOMB
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 601-664-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------