Provider Demographics
NPI:1407269756
Name:EAST MISSISSIPPI STATE HOSPITAL
Entity Type:Organization
Organization Name:EAST MISSISSIPPI STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAMRICK
Authorized Official - Last Name:ENTREKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-581-7969
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39304-4128
Mailing Address - Country:US
Mailing Address - Phone:601-581-7562
Mailing Address - Fax:601-581-7707
Practice Address - Street 1:1401 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5345
Practice Address - Country:US
Practice Address - Phone:601-587-7562
Practice Address - Fax:601-581-7707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADLEY A. SANDERS ADOLESCENT COMPLEX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-04
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31-136273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit