Provider Demographics
NPI:1730295585
Name:NORTH MISSISSIPPI MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CENTER
Other - Org Name:BEHAVIORAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3136
Mailing Address - Street 1:450 E PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5599
Mailing Address - Country:US
Mailing Address - Phone:662-377-4685
Mailing Address - Fax:662-377-2755
Practice Address - Street 1:4577 S EASON BLVD STE E F
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6590
Practice Address - Country:US
Practice Address - Phone:662-377-7590
Practice Address - Fax:662-377-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCA5810OtherRAILROAD MEDICARE
MS09015827Medicaid
MSCJ3596OtherRAILROAD MEDICARE
MS09015827Medicaid