Ellisville State School
NPI #1720181191 in Ellisville, Mississippi
Provider Information
- NPI Number
- 1720181191
- Entity Type
- Organization
- Organization Name
- Ellisville State School
- Primary Specialty
- Health Maintenance Organization
- Enumeration Date
- Sep 7, 2006
- Last Updated
- Jun 12, 2008
Practice Location
- Address
- 1101 HIGHWAY 11 S
- City
- Ellisville
- State
- Mississippi
- ZIP Code
- 39437-4443
- Phone
- (601) 477-9384
Authorized Official
- Name
- MRS. PAM K YOUNG
- Title
- ACCOUNTING AUDITOR 1
- Phone
- (601) 477-5606
Specialties & Taxonomy Codes
| Specialty |
|---|
| Health Maintenance Organization |
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