MEDICARE: 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	T-3218	MS

General Provider Information

NPI Number	:	1760921894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	764 LAKELAND DR
Second Line	:	2ND FLOOR
City	:	JACKSON
State	:	MS
Zip	:	39216-4651
Country	:	US
Telephone Number	:	601-984-6800
Fax Number	:	601-984-6812

Provider Business Practice Location Address
First Line	:	764 LAKELAND DR
Second Line	:	2ND FLOOR
City	:	JACKSON
State	:	MS
Zip	:	39216-4651
Country	:	US
Telephone Number	:	601-984-6800
Fax Number	:	601-984-6812

Authorized Official
Title or Position	:	FAMILY MEDICINE RESIDENT PHYSICIAN
Name	:	KATHERINE STACHOWICZ
Credential	:	DO
Telephone Number	:	601-984-6800

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	02/22/2017

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