1841620846 NPI number — STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

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 1841620846 NPI number — STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
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:
UNIVERSITY OF MISSISSIPPI MEDICAL CENTER-GRENADA WOMEN'S SERVICES
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:
1841620846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 CLINTON CENTER DRIVE
Provider Second Line Business Mailing Address:
CBO SUITE 4300
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-815-2005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 AVENT DR FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRENADA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38901-5230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-226-5121
Provider Business Practice Location Address Fax Number:
662-226-7529
Provider Enumeration Date:
11/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WHITTEMORE
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
601-984-5017

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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