Provider Demographics
NPI:1801010988
Name:STATE OF MS UMC NEWBORN TRANSPORT
Entity Type:Organization
Organization Name:STATE OF MS UMC NEWBORN TRANSPORT
Other - Org Name:THE UNIVERSITY OF NISS MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF NEWBORN TRANSPORT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-815-5207
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-5207
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS000189603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00050077Medicaid
MS00018960OtherBLUE CROSS OF MS