Healthcare Provider Details

I. General information

NPI: 1346833829
Provider Name (Legal Business Name): NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 06/13/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16072 BOUNDARY DR
ASHLAND MS
38603
US

IV. Provider business mailing address

PO BOX 92 15921 BOUNDARY DRIVE
ASHLAND MS
38603-0092
US

V. Phone/Fax

Practice location:
  • Phone: 662-471-9444
  • Fax: 662-346-2663
Mailing address:
  • Phone: 662-224-8951
  • Fax: 662-224-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HARDEE STONE
Title or Position: CEO
Credential:
Phone: 662-502-3149