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Brandywine Health Services of Mississippi, Inc

Organization Active NPI Emergency Medicine Physician · Ackerman, MS

NPI 1043331853 · NPPES record last updated May 28, 2008

Key facts

NPI
1043331853
Entity type
Organization (NPI type 2)
Primary specialty
Emergency Medicine Physician 207P00000X
License
16191 (MS)
Legal business name
BRANDYWINE HEALTH SERVICES OF MISSISSIPPI, INC
Practice address
311 West Cherry Street
Ackerman, MS 39735
Phone
(662) 285-6235
Fax
(662) 285-2516
NPI assigned
Apr 2, 2007
Organization subpart
No

Authorized official

Name
Ray Shoemaker
Title
Ceo
Phone
(662) 321-1155

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Brandywine Health Services of Mississippi Inc (4 organizations share this tax ID)

Locations

24224 MS Highway 15
Mathiston, MS 39752
Phone (662) 263-3194

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207P00000X 16191 MS Yes

Addresses

Primary practice location

311 West Cherry Street
Ackerman, MS 39735

Mailing address

311 West Cherry Street
Ackerman, MS 39735
Phone (662) 285-6235

Other identifiers

IdentifierTypeStateIssuer
04351270MedicaidMS

Other names

  • Choctaw County Medical Center, ERP Doing business as

Other providers in Ackerman, MS

All providers in Ackerman, MS · Emergency Medicine Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.