1336546654 NPI number — MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC

Table of content: MR. ARCHIE AUGUSTUS CUNNINGHAM II (NPI 1003681248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336546654 NPI number — MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, 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:
1336546654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 E WOODROW WILSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-5112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1207 OFFICE PARK DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-9331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-936-8899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ARMSTRONG
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
601-981-2611

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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