MEDICARE: TUNICA COUNTY HEALTHCARE AUTHORITY

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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1700642543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUNICA COUNTY HEALTHCARE AUTHORITY

Provider Business Mailing Address
First Line	:	1813 HIGHWAY 61 N STE A
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9683
Country	:	US
Telephone Number	:	662-357-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 HIGHWAY 61 N STE A
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9683
Country	:	US
Telephone Number	:	662-357-0012
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LELA MAE JONES
Credential	:
Telephone Number	:	662-541-1110

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “TUNICA COUNTY HEALTHCARE AUTHORITY ” Practice Location

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