Healthcare Provider Details

I. General information

NPI: 1821092552
Provider Name (Legal Business Name): NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15921 BOUNDARY DR
ASHLAND MS
38603-7740
US

IV. Provider business mailing address

PO BOX 92
ASHLAND MS
38603-0092
US

V. Phone/Fax

Practice location:
  • Phone: 662-224-8951
  • Fax: 662-224-6801
Mailing address:
  • Phone: 662-224-8951
  • Fax: 662-224-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number15021
License Number StateMS

VIII. Authorized Official

Name: MR. JAMES D NUNNALLY
Title or Position: CEO
Credential:
Phone: 662-224-8951