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DSH250004 NORTH MISSISSIPPI MEDICAL CENTER (Active)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004
Medicare Provider Number
250004
Additional Details
Current Program Status
Active
Registration Date
9/10/2007
Participating Start Date
1/1/2005
Participating Approval Date
9/10/2007
Last Recertification Date
9/6/2024
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
830 SOUTH GLOSTER ST
TUPELO, MS 38801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/1/07 REMOVED MEDICAID# (WAS 0330099)
09/10/2007
April 2025
April 2025
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