Provider Demographics
NPI:1881059921
Name:EAST CENTRAL MISSISSIPPI HEALTH NETWORK INCORPORATED
Entity type:Organization
Organization Name:EAST CENTRAL MISSISSIPPI HEALTH NETWORK INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-482-4955
Mailing Address - Street 1:2514 67TH AVENUE LOOP
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-7259
Mailing Address - Country:US
Mailing Address - Phone:601-482-4955
Mailing Address - Fax:601-482-4957
Practice Address - Street 1:2514 67TH AVENUE LOOP
Practice Address - Street 2:SUITE 112
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307
Practice Address - Country:US
Practice Address - Phone:601-527-5679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty