Healthcare Provider Details

I. General information

NPI: 1689028391
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 W OXFORD LOOP # 110
OXFORD MS
38655-5714
US

IV. Provider business mailing address

2704 W OXFORD LOOP # 110
OXFORD MS
38655-5714
US

V. Phone/Fax

Practice location:
  • Phone: 662-236-5773
  • Fax:
Mailing address:
  • Phone: 662-236-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH REPPERT
Title or Position: EXECUTIVE VP
Credential:
Phone: 662-377-3000