Provider Demographics
NPI:1831137512
Name:TUPELO PATHOLOGY GROUP, P.A.
Entity Type:Organization
Organization Name:TUPELO PATHOLOGY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-620-1468
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-1507
Mailing Address - Country:US
Mailing Address - Phone:662-620-1468
Mailing Address - Fax:662-844-8298
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-620-1468
Practice Address - Fax:662-844-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015994Medicaid
MS09015994Medicaid