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DSH250004AD NORTH MISSISSIPPI MEDICAL CENTER (Approved)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
North MS Dermatology Clinic (Dermatology Consultants) - Dermatology Consultants
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004AD
Medicare Provider Number
250004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/11/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/24/2025
Last Recertification Date
Contacts
Authorizing Official
North Mississippi Medical Center
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Primary Contact
North Mississippi Medical Center
Patti Hawkins, Director
(662) 377-4731
Addresses
Street Address
408 Council Cir Ste C
Tupelo, MS 38801-4949
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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