Healthcare Provider Details

I. General information

NPI: 1336361914
Provider Name (Legal Business Name): NORTH MISSISSIPPI SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EUREKA ST SUITE B
BATESVILLE MS
38606-2534
US

IV. Provider business mailing address

PO BOX 1204
OXFORD MS
38655-1204
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-5820
  • Fax: 662-234-6331
Mailing address:
  • Phone: 662-234-5820
  • Fax: 662-234-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number542011
License Number StateMS

VIII. Authorized Official

Name: MRS. PAMELA L GREENWAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-563-7728