NPIMap

Organization Active NPI

Midsouth Spine and Pain Associates PLLC

  • Specialist
  • Corinth, MS
National Provider Identifier
1013464882
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
14758 Issued in MS
Legal business name
MIDSOUTH SPINE AND PAIN ASSOCIATES PLLC
Practice address
3037 Corder Dr
Corinth, MS 38834-6216
Phone
(662) 284-8565
Fax
(662) 594-8366
NPI assigned
Sep 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brent A Grimes, NP-C
Title
NP-C/Partner
Phone
(662) 284-8565

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 14758 MS Primary
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X 701122 MS
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 16792 MS

Addresses

Primary practice location

3037 Corder Dr
Corinth, MS 38834-6216

Mailing address

PO Box 1740
Corinth, MS 38835-1740
Phone (662) 284-8565

National Provider Directory

National Provider Directory

Locations

3196 Highway 72 W
Corinth, MS 38834
Phone (662) 284-8565

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1013464882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1740",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388351740",
            "telephone_number": "662-284-8565",
            "fax_number": "662-594-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3037 CORDER DR",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388346216",
            "telephone_number": "662-284-8565",
            "fax_number": "662-594-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH SPINE AND PAIN ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-08",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NP-C/PARTNER",
        "authorized_official_telephone_number": "662-284-8565",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MS",
            "license": "14758",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "701122",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "16792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corinth, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.