Provider Demographics
NPI:1588015713
Name:UHS OF PARKWOOD INC
Entity Type:Organization
Organization Name:UHS OF PARKWOOD INC
Other - Org Name:PARKWOOD BEHAVIORAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DENEGRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-893-7102
Mailing Address - Street 1:8135 GOODMAN ROAD
Mailing Address - Street 2:BUILDING D
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654
Mailing Address - Country:US
Mailing Address - Phone:662-893-7033
Mailing Address - Fax:662-893-7060
Practice Address - Street 1:8135 GOODMAN RD BLDG D
Practice Address - Street 2:BUILDING D
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2103
Practice Address - Country:US
Practice Address - Phone:662-893-7033
Practice Address - Fax:662-893-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS14612/2.63336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05423562Medicaid
2160441OtherPK