Provider Demographics
NPI:1891169306
Name:F.C. OF MISSISSIPPI, INC.
Entity Type:Organization
Organization Name:F.C. OF MISSISSIPPI, INC.
Other - Org Name:INTREPID USA HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:3220 KELLER SPRINGS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5911
Mailing Address - Country:US
Mailing Address - Phone:214-442-0967
Mailing Address - Fax:214-445-3994
Practice Address - Street 1:885 FERNCLIFF DRIVE
Practice Address - Street 2:SUTIES 1 & 3
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2433
Practice Address - Country:US
Practice Address - Phone:662-393-0109
Practice Address - Fax:662-393-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7294251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health