Provider Demographics
NPI:1437541554
Name:SAMS, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-3955
Mailing Address - Country:US
Mailing Address - Phone:662-432-1900
Mailing Address - Fax:662-404-7022
Practice Address - Street 1:398 E MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4037
Practice Address - Country:US
Practice Address - Phone:662-432-1900
Practice Address - Fax:662-404-7022
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS305S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service