Provider Demographics
NPI:1033222922
Name:CENTRAL MISSISSIPPI MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL MISSISSIPPI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:HOSPITAL
Authorized Official - Phone:601-376-1033
Mailing Address - Street 1:1850 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:39204
Mailing Address - Country:US
Mailing Address - Phone:601-376-1033
Mailing Address - Fax:601-376-1144
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-376-1033
Practice Address - Fax:601-376-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC00220630Medicaid