Provider Demographics
NPI:1679529028
Name:EAST CENTRAL MISSISSIPPI HEALTH CARE, INC.
Entity Type:Organization
Organization Name:EAST CENTRAL MISSISSIPPI HEALTH CARE, INC.
Other - Org Name:PHILADELPHIA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS. DEPT./MIS
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCPHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-625-7140
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:MS
Mailing Address - Zip Code:39359
Mailing Address - Country:US
Mailing Address - Phone:601-625-7140
Mailing Address - Fax:601-625-7199
Practice Address - Street 1:10330 ROAD 375
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3249
Practice Address - Country:US
Practice Address - Phone:601-656-0226
Practice Address - Fax:601-656-0226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CENTRAL MISSISSIPPI HEALTH CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02184Medicaid
MS09014178Medicaid
DA1146OtherRAILROAD MEDICARE
251851Medicare Oscar/Certification