Organization
MISSISSIPPI BAND OF CHOCTAW INDIANS
Active
Parent organization
MISSISSIPPI BAND OF CHOCTAW INDIANS
Other names
CHOCTAW HEALTH CENTER DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSISSIPPI BAND OF CHOCTAW INDIANS
Authorized official
MRS. PHYLLIS J ANDERSON (TRIBAL CHIEF)
(601) 656-5251
Entity
Organization
Contact information
Practice address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 389-6342
(601) 663-7721
Mailing address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 389-6342
(601) 663-7721
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010359
BC BS DENTAL PROVIDER NUM
MS
05
—
9013488
—
MS
Enumeration date
06/05/2007
Last updated
06/15/2012
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