Provider Demographics
NPI:1285042416
Name:TUNICA COUNTY HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:TUNICA COUNTY HEALTHCARE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECURTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEANDRIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ECHOLS COBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-357-0012
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-0789
Mailing Address - Country:US
Mailing Address - Phone:662-357-0012
Mailing Address - Fax:667-357-0021
Practice Address - Street 1:1813 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9683
Practice Address - Country:US
Practice Address - Phone:662-357-0012
Practice Address - Fax:662-357-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03426Medicare UPIN