Healthcare Provider Details

I. General information

NPI: 1891923090
Provider Name (Legal Business Name): NORTH MISSISSIPPI HEMATOLOGY & ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HIGHWAY 182 WEST
STARKVILLE MS
39759
US

IV. Provider business mailing address

961 S GLOSTER ST
TUPELO MS
38801-6343
US

V. Phone/Fax

Practice location:
  • Phone: 662-320-8545
  • Fax: 662-320-8049
Mailing address:
  • Phone: 662-844-9166
  • Fax: 662-844-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number17646
License Number StateMS

VIII. Authorized Official

Name: MS. DENISE C WALTERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-844-9166