Provider Demographics
NPI:1972065829
Name:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-224-8951
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-0092
Mailing Address - Country:US
Mailing Address - Phone:662-224-8951
Mailing Address - Fax:662-224-6801
Practice Address - Street 1:15921 BOUNDARY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7740
Practice Address - Country:US
Practice Address - Phone:662-224-8951
Practice Address - Fax:662-224-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09011971Medicaid