1053335497 NPI number — MISSISSIPPI STATE HOSPITAL AT WHITFIELD

Table of content: (NPI 1053335497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053335497 NPI number — MISSISSIPPI STATE HOSPITAL AT WHITFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSISSIPPI STATE HOSPITAL AT WHITFIELD
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:
OAK CIRCLE CENTER PHYSICIANS
Provider Other Organization Name Type Code:
5
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:
1053335497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1 - FISCAL SERVICES
Provider Second Line Business Mailing Address:
3550 HWY 468 WEST
Provider Business Mailing Address City Name:
WHITFIELD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39193-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-351-8000
Provider Business Mailing Address Fax Number:
601-351-8586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3550 HWY 468 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITFIELD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39193-0157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-351-8000
Provider Business Practice Location Address Fax Number:
601-351-8586
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHASTAIN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
601-351-8000

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  31-320 , 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: 09014435 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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