Provider Demographics
NPI:1295801785
Name:UNITED HEALTHCARE AND HOSPICE
Entity type:Organization
Organization Name:UNITED HEALTHCARE AND HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORKERN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-573-0386
Mailing Address - Street 1:558 HIGHWAY 6 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-3002
Mailing Address - Country:US
Mailing Address - Phone:662-934-2981
Mailing Address - Fax:
Practice Address - Street 1:558 HIGHWAY 6 E
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3002
Practice Address - Country:US
Practice Address - Phone:662-934-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS106251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08283071Medicaid
251609OtherMEDICARE PROVIDER NUMBER
251609OtherMEDICARE PROVIDER NUMBER