Provider Demographics
NPI:1649155318
Name:NORTHWEST MISS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:NORTHWEST MISS REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-624-3463
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1218
Mailing Address - Country:US
Mailing Address - Phone:662-624-3467
Mailing Address - Fax:662-624-3413
Practice Address - Street 1:785 OHIO AVE STE 1G
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6213
Practice Address - Country:US
Practice Address - Phone:662-627-2509
Practice Address - Fax:662-627-2420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MISS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health