Provider Demographics
NPI:1578785135
Name:NORTH MISSISSIPPI SPINE CENTER
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-563-7728
Mailing Address - Street 1:109 EUREKA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606
Mailing Address - Country:US
Mailing Address - Phone:662-563-7728
Mailing Address - Fax:662-563-4888
Practice Address - Street 1:109 EUREKA ST
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-563-7728
Practice Address - Fax:662-563-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS542011293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04584863Medicaid
MSY36536Medicare UPIN
MS470000072Medicare PIN