Healthcare Provider Details

I. General information

NPI: 1053797621
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HIGHWAY 182 W
STARKVILLE MS
39759-9820
US

IV. Provider business mailing address

1205 HIGHWAY 182 W
STARKVILLE MS
39759-9820
US

V. Phone/Fax

Practice location:
  • Phone: 662-320-8545
  • Fax: 662-320-8981
Mailing address:
  • Phone: 662-320-8545
  • Fax: 662-320-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH REPPERT
Title or Position: VICE PRESIDENT
Credential:
Phone: 662-377-3978