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DSH250004A NORTH MISSISSIPPI MEDICAL CENTER (Active)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
NMMC OUTPATIENT INFUSION
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004A
Medicare Provider Number
250004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/10/2007
Participating Start Date
7/1/2005
Participating Approval Date
9/10/2007
Last Recertification Date
8/14/2024
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
990 SOUTH MADISON STREET, SUITE 2
TUPELO, MS 38801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/17/08-UPDATED ADDRESS (WAS 812 GARFIELD ST.)
09/10/2007
April 2025
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