Provider Demographics
NPI:1740382852
Name:NORTH MISSISSIPPI MEDICAL CLINICS INC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CLINICS INC
Other - Org Name:THE WOMEN'S GROUP COLUMBUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-4685
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 1:2031 HIGHWAY 45 N
Practice Address - Street 2:UNIVERSITY MALL
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2227
Practice Address - Country:US
Practice Address - Phone:662-327-5902
Practice Address - Fax:662-327-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014654Medicaid