Provider Demographics
NPI:1255387619
Name:EAST CENTRAL MISSISSIPPI HEALTH CARE, INC
Entity type:Organization
Organization Name:EAST CENTRAL MISSISSIPPI HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-625-7140
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:MS
Mailing Address - Zip Code:39359
Mailing Address - Country:US
Mailing Address - Phone:601-625-7140
Mailing Address - Fax:601-625-7199
Practice Address - Street 1:199 RIMMER ST
Practice Address - Street 2:
Practice Address - City:WALNUT GROVE
Practice Address - State:MS
Practice Address - Zip Code:39189
Practice Address - Country:US
Practice Address - Phone:601-253-2733
Practice Address - Fax:601-253-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013670Medicaid
DA1146OtherRAILROAD MEDICARE
DA1146OtherRAILROAD MEDICARE
MSC02184Medicare ID - Type Unspecified