Organization
MISSISSIPPI BAND OF CHOCTAW INDIANS
Active
Parent organization
MISSISSIPPI BAND OF CHOCTAW INDIANS
Other names
CHOCTAW RESIDENTIAL CENTER PHYSICIANS
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSISSIPPI BAND OF CHOCTAW INDIANS
Authorized official
PHYLLIS J ANDERSON (TRIBAL CHIEF)
(601) 656-5251
Entity
Organization
Contact information
Practice address
135 HOSPITAL CIR, CHOCTAW, MS 39350-6780
(601) 656-2582
Mailing address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 656-2211
(601) 663-7721
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
583
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015768
—
MS
Enumeration date
03/07/2008
Last updated
07/02/2012
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