MEDICARE: MS HUD DIXIE LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1063673820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS HUD DIXIE LLC

Provider Business Mailing Address
First Line	:	40 PALAFOX PL
Second Line	:	SUITE 400
City	:	PENSACOLA
State	:	FL
Zip	:	32502-5697
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	538 MENGE AVE
Second Line	:
City	:	PASS CHRISTIAN
State	:	MS
Zip	:	39571-4234
Country	:	US
Telephone Number	:	228-452-4344
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	SHERYL A WOLF
Credential	:
Telephone Number	:	850-430-0000

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	11/02/2020

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Directions to “MS HUD DIXIE LLC ” Practice Location

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