Provider Demographics
NPI:1619209301
Name:AMEDISYS MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:AMEDISYS MISSISSIPPI, LLC
Other - Org Name:AMEDISYS HOME HEALTH OF PICAYUNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:509 HIGHWAY 11 N
Practice Address - Street 2:SUITE B
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3349
Practice Address - Country:US
Practice Address - Phone:601-799-2626
Practice Address - Fax:601-799-0839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS MISSISSIPPI, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-04
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9595251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07626363OtherHOMEMAKER SERVICES
MS00770086Medicaid