| NPI | 1538204094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA D HAYNES Director Administrative Services 662-842-6776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MS 1000) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |