Provider Demographics
NPI:1346424819
Name:NORTH MISSISSIPPI VASCULAR CENTER, PA
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI VASCULAR CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-842-2170
Mailing Address - Street 1:1040A S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6300
Mailing Address - Country:US
Mailing Address - Phone:662-842-2170
Mailing Address - Fax:662-842-2399
Practice Address - Street 1:1040A S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6300
Practice Address - Country:US
Practice Address - Phone:662-842-2170
Practice Address - Fax:662-842-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07430261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC48456Medicare UPIN