Organization
MISSISSIPPI STATE DEPARTMENT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL S LUCIUS (CHIEF ADMINISTRATIVE OFFICER)
(601) 576-7853
Entity
Organization
Contact information
Practice address
8705 NORTHWEST DR, SUITE 1, SOUTHAVEN, MS 38671-2430
(662) 393-2775
Mailing address
PO BOX 1700, JACKSON, MS 39215-1700
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00020500
—
MS
Enumeration date
10/27/2011
Last updated
10/27/2011
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