=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497785646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH MISSISSIPPI HOSPICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 02/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 S. THOMAS ST. STE. 105
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-620-1050
-----------------------------------------------------
Fax | 662-620-1007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 PROFESSIONAL LANE, SUITE C
-----------------------------------------------------
City | PAWLEYS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-979-7079
-----------------------------------------------------
Fax | 843-979-7057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GARY C. COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-979-7079
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 150
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------