Provider Demographics
NPI:1508812694
Name:MCHANNA & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MCHANNA & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-981-4262
Mailing Address - Street 1:1855 LAKELAND DR
Mailing Address - Street 2:SUITE R204
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4913
Mailing Address - Country:US
Mailing Address - Phone:601-981-4262
Mailing Address - Fax:601-981-4264
Practice Address - Street 1:1855 LAKELAND DR
Practice Address - Street 2:SUITE R204
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4913
Practice Address - Country:US
Practice Address - Phone:601-981-4262
Practice Address - Fax:601-981-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS03530/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0440409Medicaid
MS0440409Medicaid