Provider Demographics
NPI:1467556092
Name:SOUTHWEST MISSISSIPPI PLANNING AND DEVELOPMENT DISTRICT
Entity Type:Organization
Organization Name:SOUTHWEST MISSISSIPPI PLANNING AND DEVELOPMENT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WIRT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-446-6044
Mailing Address - Street 1:100 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3477
Mailing Address - Country:US
Mailing Address - Phone:601-446-6044
Mailing Address - Fax:601-446-6071
Practice Address - Street 1:100 S WALL ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3477
Practice Address - Country:US
Practice Address - Phone:601-446-6044
Practice Address - Fax:601-446-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770314Medicaid