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General NPI Number Information
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NPI Number | 1780423715
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Entity Type | Organization
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Legal Business Name | NORTHWEST MISS REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 2000 N STATE ST STE A
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City | CLARKSDALE
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State | MS
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Zip | 38614-6100
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Country | US
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Telephone | 662-627-7361
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | CLARKSDALE
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State | MS
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Zip | 38614-0340
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Country | US
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Telephone | 662-624-3480
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LORIE TILL
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Credential |
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Telephone | 662-624-3480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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