Provider Demographics
NPI:1073626511
Name:REGION TEN STATE OF MS
Entity Type:Organization
Organization Name:REGION TEN STATE OF MS
Other - Org Name:WEEMS COMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KAHLMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:601-483-4821
Mailing Address - Street 1:PO BOX 4378
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39304-4378
Mailing Address - Country:US
Mailing Address - Phone:601-483-4821
Mailing Address - Fax:601-485-0223
Practice Address - Street 1:1415 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5345
Practice Address - Country:US
Practice Address - Phone:601-483-4821
Practice Address - Fax:601-485-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR10-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018210Medicaid
MS00018210Medicaid