MEDICARE: MISSISSIPPI STATE HOSPITAL AT WHITFIELD

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	320800000X	Mental Illness Community Based Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility	DCS-MSH	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

General Provider Information

NPI Number	:	1336224179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI STATE HOSPITAL AT WHITFIELD

Provider Business Mailing Address
First Line	:	P.O. BOX 1 - FISCAL SERVICES
Second Line	:	3550 HIGHWAY 468 WEST
City	:	WHITFIELD
State	:	MS
Zip	:	39193-0157
Country	:	US
Telephone Number	:	601-351-8000
Fax Number	:	601-351-8301

Provider Business Practice Location Address
First Line	:	350 CAPERS AVENUE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39203
Country	:	US
Telephone Number	:	601-351-8000
Fax Number	:	601-351-8301

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JAMES G CHASTAIN
Credential	:
Telephone Number	:	601-351-8000

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	03/14/2012

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Directions to “MISSISSIPPI STATE HOSPITAL AT WHITFIELD ” Practice Location

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