Provider Demographics
NPI:1184112013
Name:CLAY COUNTY MEDICAL CORPORATION
Entity type:Organization
Organization Name:CLAY COUNTY MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-4229
Mailing Address - Street 1:808 VARSITY DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4613
Mailing Address - Country:US
Mailing Address - Phone:662-377-2774
Mailing Address - Fax:662-377-2057
Practice Address - Street 1:1205 HIGHWAY 182 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9820
Practice Address - Country:US
Practice Address - Phone:662-320-8545
Practice Address - Fax:662-320-8981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORHT MISSISSIPPI HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-26
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207RH0003X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000382331Medicaid
MS355782OtherMEDICARE