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DSH250004X NORTH MISSISSIPPI MEDICAL CENTER (Active)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
Diabetes Treatment Center - Diabetes and Endocrine Disorders
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004X
Medicare Provider Number
250004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/31/2023
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
410 Council Circle
Tupelo, MS 38801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2020, terminated 10/1/2022. Reinstated 10/1/2023.
07/19/2023
April 2025
April 2025
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