Healthcare Provider Details

I. General information

NPI: 1811089980
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

IV. Provider business mailing address

PO BOX 4018
TUPELO MS
38803-4018
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4685
  • Fax: 662-377-2755
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD WAGES
Title or Position: COO
Credential:
Phone: 662-377-3000