Healthcare Provider Details

I. General information

NPI: 1376009407
Provider Name (Legal Business Name): NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16025 BOUNDARY DRIVE
ASHLAND MS
38603
US

IV. Provider business mailing address

PO BOX 92
ASHLAND MS
38603-0092
US

V. Phone/Fax

Practice location:
  • Phone: 662-502-3137
  • Fax: 662-224-6801
Mailing address:
  • Phone: 662-502-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TAMMY G CHAPMAN
Title or Position: CFO
Credential:
Phone: 662-224-8951