Provider Demographics
NPI:1699721209
Name:EAST CENTRAL MISSISSIPPI HEALTH CARE INC
Entity type:Organization
Organization Name:EAST CENTRAL MISSISSIPPI HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MIS INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCPHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-625-7140
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:MS
Mailing Address - Zip Code:39359
Mailing Address - Country:US
Mailing Address - Phone:601-625-7140
Mailing Address - Fax:601-625-7199
Practice Address - Street 1:1488 HWY 487
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:MS
Practice Address - Zip Code:39359
Practice Address - Country:US
Practice Address - Phone:601-625-7140
Practice Address - Fax:601-625-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA1146OtherRAILROAD MEDICARE
MS09010024Medicaid
MS09010024Medicaid
251829Medicare ID - Type UnspecifiedUGS