Provider Demographics
NPI: | 1053469486 |
---|---|
Name: | NORTH MISSISSIPPI MEDICAL CLINICS INC |
Entity type: | Organization |
Organization Name: | NORTH MISSISSIPPI MEDICAL CLINICS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CORPORATE SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRUCE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TOPPIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 662-377-4229 |
Mailing Address - Street 1: | 808 VARSITY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | TUPELO |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 38801-4613 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 662-377-2774 |
Mailing Address - Fax: | 662-377-2057 |
Practice Address - Street 1: | 808 VARSITY DR |
Practice Address - Street 2: | |
Practice Address - City: | TUPELO |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38801-4613 |
Practice Address - Country: | US |
Practice Address - Phone: | 662-377-4685 |
Practice Address - Fax: | 662-377-2057 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-08 |
Last Update Date: | 2025-01-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | I345 | Other | MEDICARE GROUP |
MS | CA7889 | Other | RAILROAD MEDICARE GROUP |
AL | F097 | Other | MEDICARE GROUP |
MS | C02394 | Medicare PIN |