Healthcare Provider Details

I. General information

NPI: 1295827004
Provider Name (Legal Business Name): NORTH MISSISSIPPI SPINE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EUREKA STREET SUITE B
BATESVILLE MS
38606
US

IV. Provider business mailing address

PO BOX 1204
OXFORD MS
38655-1204
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-7728
  • Fax: 662-563-4888
Mailing address:
  • Phone: 662-563-7728
  • Fax: 662-563-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number542011
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number25C0001060
License Number StateMS

VIII. Authorized Official

Name: MRS. BRIDGETTE ROCKETTE HARMON
Title or Position: MANAGER OF CLINICAL SERVICES
Credential: RN, BSN
Phone: 662-563-7728