Provider Demographics
NPI:1972608347
Name:NORTH MISSISSIPPI MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CENTER INC
Other - Org Name:BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3161
Mailing Address - Street 1:450 E PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5599
Mailing Address - Country:US
Mailing Address - Phone:662-377-4685
Mailing Address - Fax:662-377-2755
Practice Address - Street 1:4579 S EASON BLVD STE A
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6539
Practice Address - Country:US
Practice Address - Phone:662-377-3161
Practice Address - Fax:662-377-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCA5810OtherRAILROAD MEDICARE
MS09015893Medicaid
MSC02674OtherMEDICARE GROUP NUMBER
MSCJ3596OtherRAILROAD MEDICARE