Healthcare Provider Details

I. General information

NPI: 1609979053
Provider Name (Legal Business Name): PONTOTOC HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S MAIN ST
PONTOTOC MS
38863-3311
US

IV. Provider business mailing address

176 S MAIN ST
PONTOTOC MS
38863-3311
US

V. Phone/Fax

Practice location:
  • Phone: 662-488-7640
  • Fax: 662-488-7675
Mailing address:
  • Phone: 662-488-7640
  • Fax: 662-488-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number16-091
License Number StateMS

VIII. Authorized Official

Name: MR. BRUCE TOPPIN
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 662-377-4229