Healthcare Provider Details

I. General information

NPI: 1821103516
Provider Name (Legal Business Name): PONTOTOC HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
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: 662-488-5510
  • Fax: 662-488-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number16-091
License Number StateMS

VIII. Authorized Official

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