Provider Demographics
NPI:1235611765
Name:MS STATE VETERANS HOME COLLINS
Entity Type:Organization
Organization Name:MS STATE VETERANS HOME COLLINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-765-0403
Mailing Address - Street 1:3261 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-3876
Mailing Address - Country:US
Mailing Address - Phone:601-765-0519
Mailing Address - Fax:601-765-5045
Practice Address - Street 1:3261 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3876
Practice Address - Country:US
Practice Address - Phone:601-765-0403
Practice Address - Fax:601-765-5045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE VETERANS AFFAIRS BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-31
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336I0012XSuppliersPharmacyInstitutional Pharmacy