Provider Demographics
NPI:1952509580
Name:THE UNIVERSITY OF SOUTHERN MISSISSIPPI
Entity Type:Organization
Organization Name:THE UNIVERSITY OF SOUTHERN MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TO BUSINESS AND FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-266-6852
Mailing Address - Street 1:118 COLLEGE DR # 5163
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0001
Mailing Address - Country:US
Mailing Address - Phone:601-266-5163
Mailing Address - Fax:601-266-5114
Practice Address - Street 1:118 COLLEGE DR # 5163
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0001
Practice Address - Country:US
Practice Address - Phone:601-266-5163
Practice Address - Fax:601-266-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00675504Medicaid