MEDICARE: MISSISSIPPI STATE DEPARTMENT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1381	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013990530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI STATE DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	797 S JACKSON ST
Second Line	:	ROUTE 1 BOX 1049
City	:	HOUSTON
State	:	MS
Zip	:	38851-7662
Country	:	US
Telephone Number	:	662-456-3791
Fax Number	:	662-456-3979

Provider Business Practice Location Address
First Line	:	797 S JACKSON ST
Second Line	:	ROUTE 1 BOX 1049
City	:	HOUSTON
State	:	MS
Zip	:	38851-7662
Country	:	US
Telephone Number	:	662-456-3791
Fax Number	:	662-456-3979

Authorized Official
Title or Position	:	STATE HEALTH OFFICER
Name	:	DR. DANIEL P EDNEY
Credential	:	MD, FACP
Telephone Number	:	601-576-7634

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	06/30/2022

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Directions to “MISSISSIPPI STATE DEPARTMENT OF HEALTH ” Practice Location

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