=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386370369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH MISSISSIPPI MEDICAL CLINICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2022
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 HOSPITAL RD
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39759-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-323-3162
-----------------------------------------------------
Fax | 662-323-1711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 VARSITY DR
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-377-2386
-----------------------------------------------------
Fax | 662-377-2057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | BRUCE TOPPIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-377-4229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------