Providence Healthcare of Ms

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

R866849 Issued in MS

Legal business name

PROVIDENCE HEALTHCARE OF MS

Practice address

6735 I-55 South Frontage Road
Suite 2-a
Byram, MS 39272

Phone

(601) 720-5460

Fax

(601) 878-0687

NPI assigned

May 8, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrich Mann, R.N.

Title

Director/Manager

Phone

(601) 720-5460

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1144665738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 502",
            "city": "TERRY",
            "state": "MS",
            "postal_code": "391700502",
            "telephone_number": "601-720-5460",
            "fax_number": "601-878-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 I-55 SOUTH FRONTAGE ROAD",
            "address_2": "SUITE 2-A",
            "city": "BYRAM",
            "state": "MS",
            "postal_code": "39272",
            "telephone_number": "601-720-5460",
            "fax_number": "601-878-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE OF MS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2015-08-27",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "PATRICH",
        "authorized_official_title_or_position": "DIRECTOR/MANAGER",
        "authorized_official_telephone_number": "601-720-5460",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MS",
            "license": "R866849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.