Provider Demographics
NPI: | 1639187024 |
---|---|
Name: | NORTH MISSISSIPPI PEDIATRICS PA |
Entity Type: | Organization |
Organization Name: | NORTH MISSISSIPPI PEDIATRICS PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MITZI |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | PARSONS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 662-844-9885 |
Mailing Address - Street 1: | 1573 MEDICAL PARK CR |
Mailing Address - Street 2: | |
Mailing Address - City: | TUPELO |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 38801 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 662-844-9885 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1573 MEDICAL PARK CR |
Practice Address - Street 2: | |
Practice Address - City: | TUPELO |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38801 |
Practice Address - Country: | US |
Practice Address - Phone: | 662-844-9885 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-03 |
Last Update Date: | 2009-09-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MS | 09014535 | Medicaid |