Provider Demographics
NPI:1407911043
Name:NORTH MISSISSIPPI HEMATOLOGY & ONCOLOGY ASSOC. LTD
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI HEMATOLOGY & ONCOLOGY ASSOC. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-9166
Mailing Address - Street 1:201 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8400
Mailing Address - Country:US
Mailing Address - Phone:662-286-3277
Mailing Address - Fax:662-286-2056
Practice Address - Street 1:201 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-8400
Practice Address - Country:US
Practice Address - Phone:662-286-3277
Practice Address - Fax:662-286-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08548332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013493Medicaid
MSC00473Medicare PIN
MS0685410003Medicare NSC