Provider Demographics
NPI:1083782775
Name:MS SCHOOL FOR THE DEAF AND BLIND
Entity Type:Organization
Organization Name:MS SCHOOL FOR THE DEAF AND BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM SUPERINTENDENT MSD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-984-8203
Mailing Address - Street 1:1253 EASTOVER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6315
Mailing Address - Country:US
Mailing Address - Phone:601-984-8036
Mailing Address - Fax:601-984-8030
Practice Address - Street 1:1253 EASTOVER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6315
Practice Address - Country:US
Practice Address - Phone:601-984-8036
Practice Address - Fax:601-984-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAO661231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00076026Medicaid
MS06575367Medicaid