1720789944 NPI number — NORTH MISSISSIPPI CLINICS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720789944 NPI number — NORTH MISSISSIPPI CLINICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MISSISSIPPI CLINICS LLC
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:
CARDIOLOGY ASSOCIATES OF NORTH MS CLINIC
Provider Other Organization Name Type Code:
3
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:
1720789944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
499 GLOSTER CREEK VLG STE A2
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:
38801-4749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-620-6800
Provider Business Mailing Address Fax Number:
662-620-6950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 ALCORN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38834-9393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-331-1973
Provider Business Practice Location Address Fax Number:
662-331-1974
Provider Enumeration Date:
03/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CHISHOLM
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-620-6800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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