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DSH250004D NORTH MISSISSIPPI MEDICAL CENTER (Terminated)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
NMMC Outpatient Infusion Annex
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004D
Medicare Provider Number
250004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/18/2013
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
10/1/2016
Site closure
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
612 Brunson
Tupelo, MS 38801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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