MEDICARE: MISSISSIPPI DEPARTMENT OF REHABILITAION SERVICES

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

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	:	1124215785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI DEPARTMENT OF REHABILITAION SERVICES

Provider Business Mailing Address
First Line	:	P.O. BOX 1698
Second Line	:	1281 HIGHWAY 51 NORTH
City	:	JACKSON
State	:	MS
Zip	:	39215-1698
Country	:	US
Telephone Number	:	601-853-5324
Fax Number	:	601-853-5301

Provider Business Practice Location Address
First Line	:	1281 HIGHWAY 51 NORTH
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39215-1698
Country	:	US
Telephone Number	:	601-853-5324
Fax Number	:	601-853-5301

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. H.S. BUTCH MCMILLAN
Credential	:
Telephone Number	:	601-853-5200

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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Directions to “MISSISSIPPI DEPARTMENT OF REHABILITAION SERVICES ” Practice Location

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