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General NPI Number Information
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NPI Number | 1073996005
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Entity Type | Organization
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Legal Business Name | NORTH MISSISSIPPI MEDICAL CLINICS INC
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 410 COUNCIL CIR
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City | TUPELO
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State | MS
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Zip | 38801-4938
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Country | US
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Telephone | 662-377-2500
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Fax | 662-377-2069
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Provider Business Mailing Address
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Address Line | 450 E PRESIDENT AVE
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City | TUPELO
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State | MS
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Zip | 38801-5599
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Country | US
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Telephone | 662-377-4685
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Fax | 662-377-2755
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GERALD KIMBROUGH
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Credential |
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Telephone | 662-377-4685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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