Provider Demographics
NPI:1063649853
Name:NORTH MISSISSIPPI FAMILY MEDICINE GROUP OF OXFORD PA
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI FAMILY MEDICINE GROUP OF OXFORD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-236-4675
Mailing Address - Street 1:1397 BELK BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5301
Mailing Address - Country:US
Mailing Address - Phone:662-236-4675
Mailing Address - Fax:662-281-0819
Practice Address - Street 1:1397 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5301
Practice Address - Country:US
Practice Address - Phone:662-236-4675
Practice Address - Fax:662-281-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I083545Medicare PIN
MS302I083544Medicare PIN
MS302G703547Medicare PIN
MS302I083546Medicare PIN