1972608347 NPI number — NORTH MISSISSIPPI MEDICAL CENTER INC

Table of content: (NPI 1972608347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972608347 NPI number — NORTH MISSISSIPPI MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MISSISSIPPI MEDICAL CENTER 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:
BEHAVIORAL HEALTH CENTER
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:
1972608347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2015
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:
662-377-4685
Provider Business Mailing Address Fax Number:
662-377-2755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4579 S EASON BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-6539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-377-3161
Provider Business Practice Location Address Fax Number:
662-377-2993
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAGES
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
662-377-3161

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CA5810 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 09015893 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: C02674 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: CJ3596 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com