Provider Demographics
NPI:1942317326
Name:NORTH MISSISSIPPI MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CENTER, INC.
Other - Org Name:NMMC HOME INFUSION SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:REPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3978
Mailing Address - Street 1:990 S MADISON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6308
Mailing Address - Country:US
Mailing Address - Phone:662-377-4919
Mailing Address - Fax:662-377-7236
Practice Address - Street 1:990 S MADISON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6308
Practice Address - Country:US
Practice Address - Phone:662-377-4919
Practice Address - Fax:662-377-7236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MISSISSIPPI MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13-063332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS40413Medicaid
MS40413Medicaid