MISSISSIPPI BAND OF CHOCTAW INDIANS NPI 1144305731

NPI Information

MISSISSIPPI BAND OF CHOCTAW INDIANS is a public health and federal clinic center in Philadelphia, MS. MISSISSIPPI BAND OF CHOCTAW INDIANS NPI is 1144305731. The provider is registered as an organization entity type.
The provider Is Doing Business As Bogue Chitto Satellite Clinic.

The provider's business location address is:

124 BIG CREEK CIR
PHILADELPHIA, MS
ZIP 39350-004
Phone: (601) 656-2211
Fax: (601) 663-7721

The provider's authorized official is Phyllis J Anderson .
The authorized official title is Tribal Chief and has the following contact phone number (601) 656-2211.

The CLIA number assigned to this NPI record is 25D0706339 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/25/2006 and was last updated on 6/15/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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