| Mississippi Band Of Choctaw Indians | |
|
210 Hospital Cir Choctaw MS 39350-6781 | |
| (601) 389-6342 | |
| (601) 663-7721 |
| Full Name | Mississippi Band Of Choctaw Indians |
|---|---|
| Speciality | Dentist |
| Location | 210 Hospital Cir, Choctaw, Mississippi |
| Authorized Official Name and Position | Phyllis J Anderson (TRIBAL CHIEF) |
| Authorized Official Contact | 6016565251 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mississippi Band Of Choctaw Indians 210 Hospital Cir Choctaw MS 39350-6781 Ph: (601) 389-6342 | Mississippi Band Of Choctaw Indians 210 Hospital Cir Choctaw MS 39350-6781 Ph: (601) 389-6342 |
| NPI Number | 1073715579 |
|---|---|
| Provider Enumeration Date | 06/05/2007 |
| Last Update Date | 06/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073715579 | NPI | - | NPPES |
| 9013488 | Medicaid | MS | |
| 000010359 | Other | MS | BC BS DENTAL PROVIDER NUM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |