MEDICARE: MISSISSIPPI STATE DEPARTMENT OF HEALTH

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	251E00000X	Home Health Agency	10081	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	:	1952384471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI STATE DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 150
Second Line	:	2071 MAGNOLIA OFFICE PARK
City	:	FOREST
State	:	MS
Zip	:	39074-0150
Country	:	US
Telephone Number	:	601-469-3043
Fax Number	:	601-469-2996

Provider Business Practice Location Address
First Line	:	2071 MAGNOLIA OFFICE PARK
Second Line	:	HIGHWAY 35 S
City	:	FOREST
State	:	MS
Zip	:	39074-0150
Country	:	US
Telephone Number	:	601-469-3043
Fax Number	:	601-469-2996

Authorized Official
Title or Position	:	DIRECTOR OF HOME HEALTH
Name	:	MRS. MELANIE BOWMAN
Credential	:	RN
Telephone Number	:	601-576-7853

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/15/2008

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Directions to “MISSISSIPPI STATE DEPARTMENT OF HEALTH ” Practice Location

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