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DSH250004AA NORTH MISSISSIPPI MEDICAL CENTER (Terminated)
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Main Details
Name
NORTH MISSISSIPPI MEDICAL CENTER
Subdivision Name
Children's Clinic Saltillo-RHC - Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250004AA
Medicare Provider Number
250004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/8/2020
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
10/1/2021
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
108 Desert Cove
Saltillo, MS 38866
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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