Provider Demographics
NPI:1760414494
Name:CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Entity Type:Organization
Organization Name:CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Other - Org Name:JACKSON HINDS COMPREHENSIVE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-362-5321
Mailing Address - Street 1:3502 W. NORTHSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-4454
Mailing Address - Country:US
Mailing Address - Phone:601-362-5321
Mailing Address - Fax:601-364-2600
Practice Address - Street 1:9700 I 20 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MS
Practice Address - Zip Code:39041-9126
Practice Address - Country:US
Practice Address - Phone:601-866-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04224781Medicaid
MS04224781Medicaid