Provider Demographics
NPI:1134320831
Name:NORTH MISSISSIPPI PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FLOUHOUSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-377-7601
Mailing Address - Street 1:4381 SOUTH EASON BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-377-7354
Mailing Address - Fax:662-377-7492
Practice Address - Street 1:4381 SOUTH EASON BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-377-7354
Practice Address - Fax:662-377-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07226383Medicaid