Provider Demographics
NPI:1093785859
Name:UHS OF PARKWOOD INC
Entity Type:Organization
Organization Name:UHS OF PARKWOOD INC
Other - Org Name:PARKWOOD BEHAVIORAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-893-7093
Mailing Address - Street 1:8135 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2103
Mailing Address - Country:US
Mailing Address - Phone:662-895-4900
Mailing Address - Fax:
Practice Address - Street 1:8135 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2103
Practice Address - Country:US
Practice Address - Phone:662-895-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32316283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS220612Medicaid
MS00220612Medicaid
MS00220612Medicaid
MS220612Medicaid
MS00220612Medicaid