1891860656 NPI number — MISSISSIPPI COMMCARE CORPORATION

Table of content: (NPI 1891860656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891860656 NPI number — MISSISSIPPI COMMCARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSISSIPPI COMMCARE CORPORATION
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:
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:
1891860656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 W CAUSEWAY APPROACH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-3082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-324-8950
Provider Business Mailing Address Fax Number:
985-624-3477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4036 HIGHWAY 8 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-843-4014
Provider Business Practice Location Address Fax Number:
662-843-5401
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PSARELLIS
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
HARVEY
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
504-324-8950

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  380 , 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: 05621394 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005621394 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000080386 . This is a "BC BS OF MISSISSIPPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com