1497131866 NPI number — REGION 8 MENTAL HEALTH

Table of content: (NPI 1497131866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497131866 NPI number — REGION 8 MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGION 8 MENTAL HEALTH
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:
1497131866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39043-0088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-824-0342
Provider Business Mailing Address Fax Number:
601-824-0349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MARQUETTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39042-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-824-0342
Provider Business Practice Location Address Fax Number:
601-824-0349
Provider Enumeration Date:
08/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SUMRALL
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
IDDS ADMINISTRATOR
Authorized Official Telephone Number:
601-824-0342

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103TM1800X , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com