NPIViewer - Provider NPI 1154317527

NPI:	1154317527
Name:	STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Entity type:	Organization
Organization Name:	STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	ASSOCIATE CFO-CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:	JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:	GRIMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	601-815-6270
Mailing Address - Street 1:	PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:	BIRMINGHAM
Mailing Address - State:	AL
Mailing Address - Zip Code:	35246-2130
Mailing Address - Country:	US
Mailing Address - Phone:	601-984-1000
Mailing Address - Fax:
Practice Address - Street 1:	2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:	JACKSON
Practice Address - State:	MS
Practice Address - Zip Code:	39216
Practice Address - Country:	US
Practice Address - Phone:	601-984-1000
Practice Address - Fax:	601-815-0434
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2005-09-21
Last Update Date:	2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
		282N00000X, 341600000X
MS	11-199	282N00000X

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	341600000X	Transportation Services	Ambulance

State	Identifier ID	ID Type	Issuer
MO	10672004	Medicaid
MI	1154317527	Medicaid
KY	1430321	Medicaid
LA	1731200	Medicaid
OH	188845	Medicaid
IN	200125970A	Medicaid
IA	908079	Medicaid
CA	XHSP42759	Medicaid
DE	1000022942	Medicaid
NC	2500001	Medicaid
MS	=========	Other	AETNA
DC	0104140	Medicaid
MS	05375086	Medicaid
NV	100510031	Medicaid
PA	18204400002	Medicaid
MS	=========	Other	TRICARE
MS	00020149	Medicaid
MS	=========	Other	BENMARK
AL	HOS1149N	Medicaid
MS	000020149	Other	STATE OF MS
MS	00550462	Medicaid
NY	1691529	Medicaid
CO	23487232	Medicaid
AR	108481105	Medicaid
NV	1185270	Medicaid
ID	2314400	Medicaid
AZ	372079	Medicaid
IL	=========	Medicaid
MS	000020149	Other	BLUE CROSS OF MS
MS	00075205	Medicaid
AK	009908195	Medicaid
TN	250001	Medicaid
MS	=========	Other	COMMERICAL
AK	HS022IP	Medicaid
AK	HS022OP	Medicaid
CA	XHSP32759	Medicaid
ID	2314400	Medicaid
AL	HOS1149N	Medicaid