1275768319 NPI number — SOUTHWEST DEVELOPMENT CORPORATION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275768319 NPI number — SOUTHWEST DEVELOPMENT CORPORATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST DEVELOPMENT CORPORATION, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1275768319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 GILCHRIST STREET
Provider Second Line Business Mailing Address:
POST OFFICE BOX 699
Provider Business Mailing Address City Name:
FAYETTE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39069-0699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-786-3955
Provider Business Mailing Address Fax Number:
601-786-3910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 GILCHRIST STREET
Provider Second Line Business Practice Location Address:
POST OFFICE BOX 699
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39069-0699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-786-3955
Provider Business Practice Location Address Fax Number:
601-786-3910
Provider Enumeration Date:
05/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
IRVING
Authorized Official First Name:
MARY
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official Telephone Number:
601-786-3955

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  09056303 , 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: 0770119 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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