=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164961330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAY COUNTY MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2017
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 MEDICAL CENTER DR
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39773-0428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-494-1509
-----------------------------------------------------
Fax | 662-494-5928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 VARSITY DR
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-377-2774
-----------------------------------------------------
Fax | 662-377-2057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | BRUCE TOPPIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-377-4229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 10281
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------