Provider Demographics
NPI:1376764167
Name:NORTH MISSISSIPPI PULMONOLOGY CLINIC INC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI PULMONOLOGY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-728-2147
Mailing Address - Street 1:100 HOSPITAL ST
Mailing Address - Street 2:#300
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3354
Mailing Address - Country:US
Mailing Address - Phone:662-728-2147
Mailing Address - Fax:662-720-3050
Practice Address - Street 1:100 HOSPITAL ST
Practice Address - Street 2:#300
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3354
Practice Address - Country:US
Practice Address - Phone:662-728-2147
Practice Address - Fax:662-720-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07824207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015803Medicaid