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Organization

MISSISSIPPI BAND OF CHOCTAW INDIANS

Active
Parent organization
MISSISSIPPI BAND OF CHOCTAW INDIANS
Other names
CHOCTAW HEALTH CENTER OPTOMETRY
Organization subpart
Yes

Provider details

NPI number
Legal business name
MISSISSIPPI BAND OF CHOCTAW INDIANS
Authorized official
MRS. PHYLLIS J ANDERSON (TRIBAL CHIEF)
(601) 389-6342
Entity
Organization

Contact information

Practice address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 656-2211
(601) 663-7721
Mailing address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 656-2211
(601) 663-7721

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09014324
MS
Enumeration date
03/02/2010
Last updated
06/15/2012
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