Provider Demographics
NPI:1740385129
Name:SPEIGHA HEALTH, INCORPORATED
Entity type:Organization
Organization Name:SPEIGHA HEALTH, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-384-2383
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BUDE
Mailing Address - State:MS
Mailing Address - Zip Code:39630-0129
Mailing Address - Country:US
Mailing Address - Phone:601-384-2383
Mailing Address - Fax:601-384-1650
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUDE
Practice Address - State:MS
Practice Address - Zip Code:39630
Practice Address - Country:US
Practice Address - Phone:601-384-2383
Practice Address - Fax:601-384-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00593/01.1333600000X, 3336C0003X, 3336L0003X, 332BX2000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640538755OtherBCBS
MS00091936Medicaid
MS00091936Medicaid
MS00440938Medicaid
1183520001Medicare PIN
MS00091936Medicaid