Provider Demographics
NPI:1851620421
Name:NORTH MISSISSIPPI MEDICAL CLINICS INC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CLINICS INC
Other - Org Name:CARDIOTHORACIC SURGERY CLINIC
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 1:830 S GLOSTER ST
Mailing Address - Street 2:3RD FLOOR EAST TOWER
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4934
Mailing Address - Country:US
Mailing Address - Phone:662-377-7170
Mailing Address - Fax:662-377-2423
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:3RD FLOOR EAST TOWER
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-7170
Practice Address - Fax:662-377-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02394OtherMEDICARE GROUP