Provider Demographics
NPI:1114189644
Name:OCH FAMILY PRACTICE ACKERMAN
Entity Type:Organization
Organization Name:OCH FAMILY PRACTICE ACKERMAN
Other - Org Name:PARSONS FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-615-2500
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:356 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-9794
Practice Address - Country:US
Practice Address - Phone:662-285-3243
Practice Address - Fax:662-285-3613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKTIBBEHA COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-269261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09409725Medicaid
MS09409725Medicaid