1275081754 NPI number — NORTH MISSISSIPPI ELECTROPHYSIOLOGY, LLC

Table of content: (NPI 1275081754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275081754 NPI number — NORTH MISSISSIPPI ELECTROPHYSIOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH MISSISSIPPI ELECTROPHYSIOLOGY, 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:
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:
1275081754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 VARSITY DR
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:
38801-4613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-377-3204
Provider Business Mailing Address Fax Number:
662-377-2057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 GLOSTER CREEK VILLAGE
Provider Second Line Business Practice Location Address:
SUITE A-2
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-620-6800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TOPPIN
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE SECRETARY
Authorized Official Telephone Number:
662-377-3000

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007173553 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 555254 . This is a "MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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