Provider Demographics
NPI:1639319585
Name:PRIORITY HEALTHCARE
Entity Type:Organization
Organization Name:PRIORITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-906-9787
Mailing Address - Street 1:PO BOX 4118
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4118
Mailing Address - Country:US
Mailing Address - Phone:601-906-9787
Mailing Address - Fax:769-257-5142
Practice Address - Street 1:5719 HIGHWAY 25
Practice Address - Street 2:STE. 206
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7105
Practice Address - Country:US
Practice Address - Phone:601-906-9787
Practice Address - Fax:769-257-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health