1275768319 NPI number — SOUTHWEST DEVELOPMENT CORPORATION, INC.

Table of content: (NPI 1275768319)

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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