1952787012 NPI number — REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM

Table of content: (NPI 1952787012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952787012 NPI number — REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGION SEVEN MENTAL HEALTH INTELLECTUAL DISABILITIES COMM
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:
1952787012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/29/2024
NPI Reactivation Date:
08/06/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 N JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STARKVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39759-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-285-6433
Provider Business Mailing Address Fax Number:
662-323-9841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
682 COLLIER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-323-9318
Provider Business Practice Location Address Fax Number:
662-323-5553
Provider Enumeration Date:
07/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DOSS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
662-323-9318

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: 003658575 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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