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DSH250004L NORTH MISSISSIPPI MEDICAL CENTER (Active)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
Neurosurgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004L
Medicare Provider Number
250004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/24/2017
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
4381 S EASON BLVD
STE 302
TUPELO, MS 38801-6584
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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