Provider Demographics
NPI:1295319424
Name:NORTH MISSISSIPPI TELEHEALTH CONSULTING LLC
Entity type:Organization
Organization Name:NORTH MISSISSIPPI TELEHEALTH CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUWALDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-200-1124
Mailing Address - Street 1:170 DANBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8624
Mailing Address - Country:US
Mailing Address - Phone:847-276-0160
Mailing Address - Fax:
Practice Address - Street 1:7900 AIRWAYS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4113
Practice Address - Country:US
Practice Address - Phone:847-276-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty