Provider Demographics
NPI:1730164674
Name:MS STATE DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:MS STATE DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-576-7853
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39215-1700
Mailing Address - Country:US
Mailing Address - Phone:601-987-4995
Mailing Address - Fax:601-987-8633
Practice Address - Street 1:350 WEST WOODROW WILSON AVENUE
Practice Address - Street 2:HINDS COUNTY HEALTH DEPARTMENT SUITE 411-A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213
Practice Address - Country:US
Practice Address - Phone:601-987-4995
Practice Address - Fax:601-987-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7881251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00070500Medicaid
MS257084Medicare ID - Type Unspecified