Provider Demographics
NPI:1790755320
Name:ORTHOPAEDIC INSTITUTE OF NORTH MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC INSTITUTE OF NORTH MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-377-2663
Mailing Address - Street 1:499 GLOSTER CREEK VLG STE G1
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4751
Mailing Address - Country:US
Mailing Address - Phone:662-377-2663
Mailing Address - Fax:662-840-5856
Practice Address - Street 1:499 GLOSTER CREEK VLG STE G1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4751
Practice Address - Country:US
Practice Address - Phone:662-377-2663
Practice Address - Fax:662-840-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016127Medicaid
MSC02722Medicare PIN
MS09016127Medicaid