Healthcare Provider Details

I. General information

NPI: 1285738518
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 A HIGHWAY 9 SOUTH
EUPORA MS
39744
US

IV. Provider business mailing address

450 EAST PRESIDENT STREET
TUPELO MS
38801
US

V. Phone/Fax

Practice location:
  • Phone: 662-258-7200
  • Fax: 662-258-9230
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD KIMBROUGH
Title or Position: MANAGER
Credential:
Phone: 662-377-4685