1639277957 NPI number — UNIVERSITY OF MISSISSIPPI

Table of content: (NPI 1639277957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639277957 NPI number — UNIVERSITY OF MISSISSIPPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MISSISSIPPI
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:
1639277957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 REBEL DRIVE
Provider Second Line Business Mailing Address:
HARRISON BLDG
Provider Business Mailing Address City Name:
UNIVERSITY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38677-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-915-5279
Provider Business Mailing Address Fax Number:
662-915-5292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 REBEL DRIVE
Provider Second Line Business Practice Location Address:
HARRISON BLDG
Provider Business Practice Location Address City Name:
UNIVERSITY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38677-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-915-5279
Provider Business Practice Location Address Fax Number:
662-915-5292
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENTLEY
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
662-915-5279

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  0222902SU , 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: 2517083 . This is a "NABP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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