Provider Demographics
NPI:1497785646
Name:NORTH MISSISSIPPI HOSPICE, INC.
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI HOSPICE, INC.
Other - Org Name:NORTH MISSISSIPPI HOSPICE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-979-7079
Mailing Address - Street 1:137 PROFESSIONAL LANE, SUITE C
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:843-979-7079
Mailing Address - Fax:843-979-7057
Practice Address - Street 1:105 S. THOMAS ST. STE. 105
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5337
Practice Address - Country:US
Practice Address - Phone:662-620-1050
Practice Address - Fax:662-620-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS150251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09206852Medicaid
251639Medicare Oscar/Certification
MS251639Medicare Oscar/Certification