Provider Demographics
NPI:1497133391
Name:MISSISSIPPI SENIOR CARE
Entity Type:Organization
Organization Name:MISSISSIPPI SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:GUNNELLS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-678-3330
Mailing Address - Street 1:86 S THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4355
Mailing Address - Country:US
Mailing Address - Phone:662-844-0400
Mailing Address - Fax:662-844-5605
Practice Address - Street 1:86 S THOMAS ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4355
Practice Address - Country:US
Practice Address - Phone:662-844-0400
Practice Address - Fax:662-844-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1382603Medicaid