Basic Information
| Provider Information | |||||||||
| NPI: | 1720039092 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY HOSPICE OF MISSISSIPPI, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRINITY HOSPICE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14180 DALLAS PKWY | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752544341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143064520 | ||||||||
| FaxNumber: | 9723860704 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 METHODIST BLVD | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288753527 | ||||||||
| FaxNumber: | 2144329220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | GLASSCOCK | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2143064520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 035 | MS | Y | Agencies | Hospice Care, Community Based |
No ID Information.