Healthcare Provider Details

I. General information

NPI: 1588768667
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 W MAIN ST
TUPELO MS
38801-9413
US

IV. Provider business mailing address

808 VARSITY DR
TUPELO MS
38801-4613
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-9376
  • Fax: 662-844-4326
Mailing address:
  • Phone: 662-377-2774
  • Fax: 662-377-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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