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Organization
PHYSICIAN GROUP
Active
Organization
PHYSICIAN GROUP
Active
Parent organization
EAST MISSISSIPPI STATE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAST MISSISSIPPI STATE HOSPITAL
Authorized official
DR. CHARLES CARLISLE (HOSPITAL DIRECTOR)
(601) 581-7877
Entity
Organization
Contact information
Practice address
4555 HIGHLAND PARK DR, MERIDIAN, MS 39307-5429
(601) 581-7969
(601) 581-7676
Mailing address
PO BOX 4128, MERIDIAN, MS 39304-4128
(601) 581-7969
(601) 581-7676
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
36-136
MS
Other
Enumeration date
09/20/2010
Last updated
05/12/2020
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