Organization
IMANI COMMUNITY OUTREACH CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA B DUNCAN (BILLER)
(601) 878-6945
Entity
Organization
Contact information
Practice address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Mailing address
301 E JEFFERSON ST, KOSCIUSKO, MS 39090-3719
(662) 289-7676
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00686258
—
MS
Enumeration date
11/30/2011
Last updated
03/12/2012
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