Provider Demographics
NPI:1811169840
Name:SOUTHWEST MISSISSIPPI PLANNING AND DEVELOPMENT DISTRICT
Entity type:Organization
Organization Name:SOUTHWEST MISSISSIPPI PLANNING AND DEVELOPMENT DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WIRT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:601-446-6044
Mailing Address - Street 1:100 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3477
Mailing Address - Country:US
Mailing Address - Phone:601-446-6044
Mailing Address - Fax:601-384-5200
Practice Address - Street 1:1477 FE SELLERS HIGHWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654
Practice Address - Country:US
Practice Address - Phone:601-587-0873
Practice Address - Fax:601-587-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770117Medicaid
MS00770314Medicaid