Healthcare Provider Details

I. General information

NPI: 1013828813
Provider Name (Legal Business Name): BENJAMIN M HIGGINBOTHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BEN HIGGINBOTHAM NRP

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11470 ROAD 539
PHILADELPHIA MS
39350-8087
US

IV. Provider business mailing address

11470 ROAD 539
PHILADELPHIA MS
39350-8087
US

V. Phone/Fax

Practice location:
  • Phone: 601-745-6472
  • Fax:
Mailing address:
  • Phone: 601-745-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1014172
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: