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Imani Community Center
Preferred Provider Organization in Kosciusko, Mississippi
NPI 1740650969

Imani Community Center is a Preferred Provider Organization based in Kosciusko, MS. Imani Community Center practices in Kosciusko, MS. The NPI Number for Imani Community Center is 1740650969 and holds a License No. 0050750 (Mississippi).

The current practice location address for Imani Community Center is 207 Poplar St, Kosciusko, MS and can be reached out via phone at 662-803-1254 and via fax at 662-289-1010.

Location: 207 Poplar St, Kosciusko, MS, 39090-4409
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1740650969
Provider Name
Imani Community Center
Credential
Provider Entity Type
Organization
Address
207 Poplar St, Kosciusko, MS, 39090-4409
Phone Number
662-803-1254
Fax Number
662-289-1010
Provider Enumeration Date
09/30/2015
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1457623118 05 MS
1275977357 05 MS
1245502962 05 MS
institution
Provider Business Practice Location Address Details
Address
207 Poplar St
City
Kosciusko
State
Mississippi
Zip
39339
Phone Number
662-803-1254
Fax Number
662-289-1010
person
Provider Business Mailing Address Details
Address
207 Poplar St
City
Kosciusko
State
Mississippi
Zip
39339
Phone Number
662-803-1254
Fax Number
662-289-1010
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
08533763 (Mississippi)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Managed Care Organizations
Classification
Preferred Provider Organization
Speciality
-
Taxonomy
305R00000X
License No.
0050750 (Mississippi)
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
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