MEDICARE: CENTRAL MS. PLANNING & DEV. DISTRICT, INC.

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

General Provider Information

NPI Number	:	1265563779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MS. PLANNING & DEV. DISTRICT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 4935
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39296-4935
Country	:	US
Telephone Number	:	601-981-1511
Fax Number	:

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	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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