Healthcare Provider Details

I. General information

NPI: 1295105922
Provider Name (Legal Business Name): TISHOMINGO HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 3RD ST
BELMONT MS
38827-7737
US

IV. Provider business mailing address

456 E PRESIDENT AVE
TUPELO MS
38801-5515
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 662-377-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number13-221
License Number StateMS

VIII. Authorized Official

Name: SHARON NOBLES
Title or Position: TREASURER
Credential:
Phone: 662-377-3360