# STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

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

## Provider details

- **NPI number:** 1619778586
- **Authorized official:** JEFFREY GRIMSLEY (ASSOCIATE CFO - CLINICAL OPERATIONS)
- **Authorized official phone:** (601) 815-6270

## Contact information

- **Practice address:** 350 W WOODROW WILSON AVE STE 600, JACKSON, MS 39213-7627
- **Practice address phone:** (601) 815-6700
- **Mailing address:** PO BOX 11407, BIRMINGHAM, AL 35246-2130
- **Mailing address phone:** (601) 815-6064

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/24/2025
- **Last updated:** 07/22/2025