MEDICARE: CENTRAL MS PLANNING & DEVELPMENT DISTRICT

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	251B00000X	Case Management Agency	0770316	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	:	1043581614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MS PLANNING & DEVELPMENT DISTRICT

Provider Business Mailing Address
First Line	:	1170 LAKELAND DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4701
Country	:	US
Telephone Number	:	601-981-1511
Fax Number	:	601-981-1515

Provider Business Practice Location Address
First Line	:	1170 LAKELAND DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4701
Country	:	US
Telephone Number	:	601-981-1511
Fax Number	:	601-981-1515

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. F CLARKE HOLMES
Credential	:
Telephone Number	:	601-981-1511

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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Directions to “CENTRAL MS PLANNING & DEVELPMENT DISTRICT ” Practice Location

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