Provider Demographics
NPI:1760921894
Name:UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STACHOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-984-6800
Mailing Address - Street 1:764 LAKELAND DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4651
Mailing Address - Country:US
Mailing Address - Phone:601-984-6800
Mailing Address - Fax:601-984-6812
Practice Address - Street 1:764 LAKELAND DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4651
Practice Address - Country:US
Practice Address - Phone:601-984-6800
Practice Address - Fax:601-984-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3218282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital