1386370369 NPI number — NORTH MISSISSIPPI MEDICAL CLINICS, INC.

Table of content: MR. EDWARD BURKE ADDISON IV BEHAVIOR ASSISTANT (NPI 1114432168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386370369 NPI number — NORTH MISSISSIPPI MEDICAL CLINICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MISSISSIPPI MEDICAL CLINICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386370369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 E PRESIDENT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38801-5599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39759-2158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-323-3162
Provider Business Practice Location Address Fax Number:
662-323-1711
Provider Enumeration Date:
08/01/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KIMBROUGH
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
662-377-5201

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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