Organization
BRANDYWINE HEALTH SERVICES OF MISSISSIPPI, INC
Active
Other names
Choctaw County Medical Center, ERP
Organization subpart
No
Provider details
NPI number
Authorized official
RAY SHOEMAKER (CEO)
(662) 321-1155
Entity
Organization
Contact information
Practice address
311 WEST CHERRY STREET, ACKERMAN, MS 39735
(662) 285-6235
(662) 285-2516
Mailing address
311 WEST CHERRY STREET, ACKERMAN, MS 39735
(662) 285-6235
(662) 285-2516
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04351270
—
MS
Enumeration date
04/02/2007
Last updated
05/28/2008
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