Provider Demographics
NPI:1942547922
Name:NORTH MISSISSIPPI ALLERGY AND ASTHMA CENTER PLLC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI ALLERGY AND ASTHMA CENTER PLLC
Other - Org Name:NORTH MISSISSIPPI ALLERGY AND ASTHMA CENTER OF STARKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-0688
Mailing Address - Street 1:501 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2158
Mailing Address - Country:US
Mailing Address - Phone:662-377-0688
Mailing Address - Fax:662-624-0684
Practice Address - Street 1:501 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2158
Practice Address - Country:US
Practice Address - Phone:662-377-0688
Practice Address - Fax:662-624-0684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MISSISSIPPI ALLERGY AND ASTHMA CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherMEDICARE GROUP PTAN 512I030005