Provider Demographics
NPI:1447367834
Name:NORTH MISSISSIPPI MEDICAL CENTER
Entity type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:662-377-4731
Mailing Address - Street 1:990 SOUTH MADISON STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-377-4919
Mailing Address - Fax:662-377-7236
Practice Address - Street 1:990 S MADISON ST
Practice Address - Street 2:STE 2
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6308
Practice Address - Country:US
Practice Address - Phone:662-377-4919
Practice Address - Fax:662-377-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336H0001X, 3336I0012X
MS043633336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS40413Medicaid
MS00330099Medicaid
2047209OtherPK