1679630008 NPI number — SOUTH MISSISSIPPI STATE HOSPITAL

Table of content: (NPI 1679630008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679630008 NPI number — SOUTH MISSISSIPPI STATE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH MISSISSIPPI STATE HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH MISSISSIPPI STATE HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679630008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 HIGHWAY 589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PURVIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39475-4194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-794-0201
Provider Business Mailing Address Fax Number:
601-794-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 HIGHWAY 589
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PURVIS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39475-4194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-794-0201
Provider Business Practice Location Address Fax Number:
601-794-0220
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASHLEY
Authorized Official First Name:
CLINT
Authorized Official Middle Name:
Authorized Official Title or Position:
HOSPITAL DIRECTOR
Authorized Official Telephone Number:
601-794-0152

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  04871/3.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2046299 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com