Provider Demographics
NPI:1346833829
Name:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC
Other - Org Name:NORTH BENTON HEALTH CARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BLU
Authorized Official - Middle Name:G
Authorized Official - Last Name:STONZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-224-8951
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:15921 BOUNDARY DRIVE
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-0092
Mailing Address - Country:US
Mailing Address - Phone:662-224-8951
Mailing Address - Fax:662-224-6801
Practice Address - Street 1:15921 BOUNDARY DRIVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603
Practice Address - Country:US
Practice Address - Phone:662-224-8951
Practice Address - Fax:662-224-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy