# MISSISSIPPI STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356208367
- **Authorized official:** DANIEL TODD HALE (DIRECTOR, FISCAL OPERATIONS, STUDEN)
- **Authorized official phone:** (662) 325-5895

## Contact information

- **Practice address:** 195 LEE BLVD, MISSISSIPPI STATE, MS 39762-9698
- **Practice address phone:** (662) 325-5895
- **Practice address fax:** (662) 325-8888
- **Mailing address:** PO BOX 6338, MISSISSIPPI STATE, MS 39762-6338
- **Mailing address phone:** (662) 325-5895
- **Mailing address fax:** (662) 325-8888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2026
- **Last updated:** 01/09/2026