Organization
EAST MISSISSIPPI STATE HOSPITAL
Active
Parent organization
EAST MISSISSIPPI STATE HOSPITAL
Other names
DENTAL CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAST MISSISSIPPI STATE HOSPITAL
Authorized official
CHARLES CARLISLE (HOSPITAL DIRECTOR)
(601) 581-7878
Entity
Organization
Contact information
Practice address
1818 COLLEGE DRIVE, REIMBURSEMENT DEPT., MERIDIAN, MS 39307-5429
(601) 581-7562
(601) 581-7676
Mailing address
PO BOX 4128, WEST STATION, MERIDIAN, MS 39304-4128
(601) 581-7562
(601) 581-7676
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
31-136
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09422269
—
MS
Enumeration date
07/20/2007
Last updated
05/12/2020
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