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NPI Code Detail

MEDICARE: MISSISSIPPI STATE DEPARTMENT OF HEALTH

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
1251K00000XPublic Health or Welfare Agency

General Provider Information

NPI Number : 1063822781
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSISSIPPI STATE DEPARTMENT OF HEALTH
Provider Business Mailing Address
First Line : 570 E WOODROW WILSON AVE
Second Line :
City : JACKSON
State : MS
Zip : 39216-4538
Country : US
Telephone Number : 601-576-7635
Fax Number :
Provider Business Practice Location Address
First Line : 252 CARTER AVE
Second Line :
City : NEW ALBANY
State : MS
Zip : 38652-3321
Country : US
Telephone Number : 662-534-1926
Fax Number : 662-534-1928
Authorized Official
Title or Position : CHIEF ADMINISTRATIVE OFFICER
Name : MR. MITCHELL ADCOCK
Credential : CAO
Telephone Number : 601-576-7635
Provider Enumeration Date : 05/02/2014
Last Update Date : 05/02/2014

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Directions to “MISSISSIPPI STATE DEPARTMENT OF HEALTH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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