Provider Demographics
NPI:1982949046
Name:NORTH MISSISSIPPI MEDICAL CENTER SERVICES LLC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI MEDICAL CENTER SERVICES LLC
Other - Org Name:ORTHO TRAUMA SERVICES CLINIC 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEH
Authorized Official - Middle Name:
Authorized Official - Last Name:REPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3978
Mailing Address - Street 1:808 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5749
Mailing Address - Country:US
Mailing Address - Phone:662-377-5265
Mailing Address - Fax:662-377-5260
Practice Address - Street 1:808 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5749
Practice Address - Country:US
Practice Address - Phone:662-377-5265
Practice Address - Fax:662-377-5260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MISSISSIPPI MEDICAL CENTER SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G707180Medicare PIN