Provider Demographics
NPI:1699285692
Name:SOUTHERN ALTERNATIVE & INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:SOUTHERN ALTERNATIVE & INTEGRATIVE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISCH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEAL MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NHC, CHW, DIRECTOR
Authorized Official - Phone:601-395-4073
Mailing Address - Street 1:331 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4752
Mailing Address - Country:US
Mailing Address - Phone:601-395-4073
Mailing Address - Fax:
Practice Address - Street 1:921 WALL ST STE B
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3161
Practice Address - Country:US
Practice Address - Phone:601-395-4073
Practice Address - Fax:601-395-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty