NPI 1720181191

Ellisville State School

Organisation Health Maintenance Organization Ellisville, MS

Practice location

Address: 1101 Highway 11 S, Ellisville, MS 39437-4443
Phone: (601) 477-9384
Fax: (601) 477-5700

Authorised official

Name: Pam K Young
Title: Accounting Auditor 1
Phone: (601) 477-5606

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence 233 (MS)

Other Health Maintenance Organization providers in Mississippi →

Registry record

NPI: 1720181191
Entity type: Organization
NPI issued: 7 Sep 2006
Record last updated: 12 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.