NPIMap

Organization Active NPI

North Mississippi Medical Center

Doing business as Advanced Wound Center Professionals

  • Family Medicine Physician
  • Tupelo, MS
National Provider Identifier
1063739290
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH MISSISSIPPI MEDICAL CENTER
Doing business as
Advanced Wound Center Professionals
Practice address
830 S Gloster St FL 4
Tupelo, MS 38801-4934
Phone
(662) 377-2395
Fax
(662) 377-2397
NPI assigned
Apr 28, 2010
Last updated
Jan 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Authorized official

Name
Bruce Toppin
Title
Corporate Secretary
Phone
(662) 377-4229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

830 S Gloster St FL 4
Tupelo, MS 38801-4934

Mailing address

808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-3204

Other identifiers 1

IdentifierTypeStateIssuer
009324007MedicaidMS

Other names 1

  • Advanced Wound Center Professionals Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040413000541 MS Part B Supplier - Clinic/Group Practice 9931010600 Receives reassigned benefits from 570 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Tupelo, MS; West Point, MS; Starkville, MS; Corinth, MS; Oxford, MS

National Provider Directory

National Provider Directory
Tax ID family
Paulo Gonzalez DO65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Locations

3302 W Linden St
#A
Corinth, MS 38834
Phone (662) 331-1956

830 S Gloster St
#4
Tupelo, MS 38801

830 S Gloster St
Fl 1
Tupelo, MS 38801
Phone (662) 377-2500

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1063739290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 VARSITY DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014613",
            "telephone_number": "662-377-3204",
            "fax_number": "662-377-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER ST FL 4",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014934",
            "telephone_number": "662-377-2395",
            "fax_number": "662-377-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "TOPPIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "662-377-4229"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009324007",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Wound Center Professionals",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Wound Center Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.