Provider Demographics
NPI:1609262955
Name:SOUTH MISSISSIPPI AIDS TASK FORCE, INC.
Entity Type:Organization
Organization Name:SOUTH MISSISSIPPI AIDS TASK FORCE, INC.
Other - Org Name:SMATF
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOURN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:228-385-1214
Mailing Address - Street 1:PO BOX 8009
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8009
Mailing Address - Country:US
Mailing Address - Phone:228-385-1214
Mailing Address - Fax:228-385-1296
Practice Address - Street 1:2756 FERNWOOD RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3520
Practice Address - Country:US
Practice Address - Phone:228-385-1214
Practice Address - Fax:228-385-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable