IMANI COMMUNITY OUTREACH CTR (NPI# 1669749081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669749081 |
| Entity Type | Organization |
| Organization Name | IMANI COMMUNITY OUTREACH CTR |
| Practice Address |
301 E Jefferson St Kosciusko MS 39090-3719 |
| Practice Telephone | 6622897676 |
| Mailing Telephone | 6622897676 |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2012-03-12 |
| Authorized Official Name | TRICIA B DUNCAN (BILLER) |
| Authorized Official Telephone | 6018786945 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 172A00000X | Driver | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00686258 | 05 |
| Street Address |
301 E JEFFERSON ST |
| City | KOSCIUSKO |
| State | MS |
| Zip Code | 39090-3719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295174555 | Imani Community Out Reach Center | Preferred Provider Organization | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2013-06-20 |
| 1154765808 | Imani Community Outreach Center | Custodial Care Facility | 301 E Jefferson St, Kosciusko, MS 39090 | 2013-04-24 |
| 1912264250 | Imani Community Outreach Ctr Inc | Home Health | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-04-11 |
| 1912273624 | Imani Community Outreach Center | Physical Therapist | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-27 |
| 1477829182 | Imani Community Outreach Center | Occupational Therapist | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-27 |
| 1467728360 | Imani Community Outreach Center | Social Worker | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-03-26 |
| 1245502962 | Imani Community Outreach Center | Homemaker | 301 E Jefferson St, Kosciusko, MS 39090-3719 | 2012-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508371675 | Caroline Boydstun Fair | Pharmacist | 109 Northside Center, Kosciusko, MS 39090 | 2017-12-11 |
| 1275069643 | Sharhonda Wingo | Speech-Language Pathologist | 2447 Attala Road 2203, Kosciusko, MS 39090 | 2017-05-04 |
| 1013392034 | Leap of Faith LLC | Respite Care | 115 North Wells Street, Suite A, Kosciusko, MS 39090 | 2015-07-21 |
| 1730566027 | Bmc - Attala, LLC | General Acute Care Hospital | 220 Hwy. 12 West, Kosciusko, MS 39090 | 2015-05-06 |
| 1528402484 | Warner Martin Myers I | Student in an Organized Health Care Education/Training Program | 912 Hwy 12 East, Kosciusko, MS 39090 | 2013-04-23 |
| 1891022547 | Medical Foundation of Central Mississippi | Internal Medicine | 329 Highway 12 West, Koscuisko, MS 39090 | 2009-11-17 |
| 1255512448 | Cheryl L Bayne | Adult Companion | 509 Hillview Dr, Kosciusko, MS 39090 | 2007-11-16 |
| 1760673982 | Gary A Cochran | Technician/Technologist | 118 West North St, Kosciusko, MS 39090 | 2007-08-05 |
| 1639396393 | Stephen C Hammack | Family Medicine | 332 Highway 12 West, Kosciusko, MS 39090 | 2007-04-20 |
| 1740329689 | Brenda Nail | Nurse Practitioner | 999 Martin Luther King Drive, Kosciusko, MS 39090 | 2007-02-06 |
| Find all providers in zip 39090 | ||||
| Taxonomy Code | 172A00000X |
| Grouping | Other Service Providers |
| Classification | Driver |
| A person employed to operate a motor vehicle as a carrier of persons or property. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992305148 | Jessica Overstreet | Driver | 1147 Pat Luckett Rd, Canton, MS 39046-9102 | 2020-10-27 |
| 1730793688 | Sharon Gaddis | Driver | 3825 Mount Charity Rd, Carthage, MS 39051-8666 | 2020-09-08 |
| 1265066138 | Sarah Howard | Driver | 5880 Ridgewood Rd Apt H65, Jackson, MS 39211-2628 | 2020-02-28 |
| 1174160758 | Andrew James Rodgers | Driver | 104 Cherry Bark Way, Pearl, MS 39208-5542 | 2019-12-03 |
| 1023653839 | Frank Stovall | Driver | 716 W Georgetown St, Crystal Springs, MS 39059-2778 | 2019-11-15 |
| 1841835006 | Jessica Hearn Hudson | Driver | 403 Westview Ln, Columbus, MS 39705-8162 | 2019-11-12 |
| 1982252300 | Valarie White | Driver | 1305 N 7th Ave, Laurel, MS 39440-2201 | 2019-08-28 |
| 1548827405 | Sonya Jeaneanne Smith | Driver | 160 Broadway St Apt J4, Clinton, MS 39056-4840 | 2019-05-24 |
| 1225694490 | Daniel Scott Morgan | Driver | 5913 Bay Tree Rd, Ocean Springs, MS 39564-2202 | 2019-05-14 |
| 1952965840 | Labrintary Jackson | Driver | 119 Herman Johnson W, Indianola, MS 38751-3664 | 2019-04-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.