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DSH250004G NORTH MISSISSIPPI MEDICAL CENTER (Active)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
Breast Care Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004G
Medicare Provider Number
250004
Outpatient Facility Provider Number
250004
Additional Details
Current Program Status
Active
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
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
4376 S Eason Blvd
Tupelo, MS 38801
Billing Address
North Mississippi Medical Center
830 South Gloster St
Tupelo, MS 38801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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