1639277957 NPI number — UNIVERSITY OF MISSISSIPPI

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 1639277957 NPI number — UNIVERSITY OF MISSISSIPPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MISSISSIPPI
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:
1639277957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 REBEL DRIVE
Provider Second Line Business Mailing Address:
HARRISON BLDG
Provider Business Mailing Address City Name:
UNIVERSITY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38677-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-915-5279
Provider Business Mailing Address Fax Number:
662-915-5292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 REBEL DRIVE
Provider Second Line Business Practice Location Address:
HARRISON BLDG
Provider Business Practice Location Address City Name:
UNIVERSITY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38677-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-915-5279
Provider Business Practice Location Address Fax Number:
662-915-5292
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENTLEY
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
662-915-5279

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  0222902SU , 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: 2517083 . This is a "NABP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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