Provider Demographics
NPI:1982936670
Name:AMEDISYS MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:AMEDISYS MISSISSIPPI, LLC
Other - Org Name:AMEDISYS HOME HEALTH OF HATTIESBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:132 MAYFAIR RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1463
Practice Address - Country:US
Practice Address - Phone:601-296-9710
Practice Address - Fax:601-296-9688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS MISSISSIPPI, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-04
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2381251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01983097OtherHOMEMAKER SERVICES
MS00070587Medicaid