1619001864 NPI number — TOTAL HEALTH CARE SERVICES, INC.

Table of content: (NPI 1619001864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619001864 NPI number — TOTAL HEALTH CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL HEALTH CARE SERVICES, 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:
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:
1619001864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 908
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELZONI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39038-0908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-453-7708
Provider Business Mailing Address Fax Number:
662-453-9856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 HIGHWAY 82 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-453-7708
Provider Business Practice Location Address Fax Number:
662-453-9856
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KILBURN
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
662-247-1254

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00770454 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00070522 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09476371 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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