Provider Demographics
NPI:1982669156
Name:NORTH MISSISSIPPI MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CENTER, INC.
Other - Org Name:NORTH MISSISSIPPI MEDICAL CENTER HOSPICE
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 1:830 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4934
Mailing Address - Country:US
Mailing Address - Phone:662-377-3000
Mailing Address - Fax:
Practice Address - Street 1:422-B EAST PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5500
Practice Address - Country:US
Practice Address - Phone:662-377-3612
Practice Address - Fax:662-377-7983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MISSISSIPPI MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000070614OtherBLUE CROSS
MS00070662Medicaid
251501Medicare Oscar/Certification