MEDICARE: STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

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	282N00000X	General Acute Care Hospital	16243	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
2	20705	OTHER	MS	BLUE CROSS

General Provider Information

NPI Number	:	1194770404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	504 CLINTON CENTER DR STE 4100
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5610
Country	:	US
Telephone Number	:	601-815-6381
Fax Number	:	601-855-5100

Provider Business Practice Location Address
First Line	:	161 RIVER OAKS DRIVE
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-5375
Country	:	US
Telephone Number	:	601-496-5500
Fax Number	:	601-855-5100

Authorized Official
Title or Position	:	ASSOCIATE CFO
Name	:	JEFFREY GRIMSLEY
Credential	:
Telephone Number	:	601-815-6270

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/20/2026

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