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Contact Information

ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS
5001 HARDY ST STE 8
HATTIESBURG, MS39402-1308
 Phone: 601-307-5339
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Clinic/Center

261Q00000X
 

Genetics

261QG0250X
 

Physiological Laboratory, (Independent Physiological Lab)

293D00000X 47 Independent Diagnostic Testing Facility (IDTF)
 

Student Health

261QS1000X
Indicates primary specialty

NPI Profile & details for ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS

NPI # 1255999835
LBN Legal business name ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS
Authorized official JACOB PARKER - (SPECIALIST TECHNOLOGIST)
Entity Organization
Organization subpart 1 Yes
Enumeration date 05/30/2019
Last updated 09/30/2020 - About 6 years ago
Identifiers
MS Medicaid 587539997
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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