Provider Demographics
NPI:1902965866
Name:OCH CENTER FOR PAIN MANAGEMENT
Entity Type:Organization
Organization Name:OCH CENTER FOR PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-615-2500
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1326
Mailing Address - Country:US
Mailing Address - Phone:662-615-2830
Mailing Address - Fax:662-615-2836
Practice Address - Street 1:107 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2174
Practice Address - Country:US
Practice Address - Phone:662-615-3751
Practice Address - Fax:662-615-3754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKTIBBEHA COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-07
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-269261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04825568Medicaid
MSC03619Medicare PIN