Provider Demographics
NPI:1346684826
Name:CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
Entity Type:Organization
Organization Name:CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
Other - Org Name:JACKSON-HINDS COMPREHENSIVE HEALTH CENTER EDWARDS SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-362-5321
Mailing Address - Street 1:3502 W NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-4454
Mailing Address - Country:US
Mailing Address - Phone:601-362-5321
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH MAGNOLIA STREET
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:MS
Practice Address - Zip Code:39066
Practice Address - Country:US
Practice Address - Phone:601-362-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-26
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)