Provider Demographics
NPI:1114054301
Name:NORTH MISSISSIPPI STATE HOSPITAL
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALLENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-690-4200
Mailing Address - Street 1:1937 BRIAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-5963
Mailing Address - Country:US
Mailing Address - Phone:662-690-4200
Mailing Address - Fax:662-690-4227
Practice Address - Street 1:1937 BRIAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5963
Practice Address - Country:US
Practice Address - Phone:662-690-4200
Practice Address - Fax:662-690-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31328283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS254009Medicare ID - Type UnspecifiedIP HOSPITALIZATION