North Mississippi Medcial Center, Inc.
Organization Active NPI Pediatrics Physician · Tupelo, MS
NPI 1235635566 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1235635566
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- NORTH MISSISSIPPI MEDCIAL CENTER, INC.
- Practice address
- 199 Grandstand Place
Ste. 101
Tupelo, MS 38804 - Phone
- (626) 377-7337
- Fax
- (662) 377-1399
- NPI assigned
- Apr 4, 2018
- Organization subpart
- No
Authorized official
- Name
- Bruce Toppin
- Title
- Secretary
- Phone
- (662) 377-4229
Corporate family (same tax ID) 22
Practitioners 17
-
Richard Kevin Cole, M.D.
-
Alice Claire Ellis Harrelson, APRN, FNP-C
-
Max Taylor, MD
-
Morgan Turner, FNP-BC
-
Maria I Aguilar, MD
-
Lorianne Elizabeth Avino, D.O.
-
Tai DO, MD
-
Mark Vincent Johnson, M.D.
-
James Lamb, MD
-
Mandy Dawn Stone, CRNP
-
Erin Smith, NURSE PRACTITIONER
-
Kellie Thornton, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Anant Shenoy MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
199 Grandstand Place
Ste. 101
Tupelo, MS 38804
Mailing address
808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-2386
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000659767 | Medicaid | MS |
Other names
- NMMC Neurodevelopmental Clinic
Other providers in Tupelo, MS
- North Mississippi Ground Ambulance, LLC
- North Mississippi Health Services, Inc.
- North Mississippi Hematology & Oncology Assoc. LTD
- North Mississippi Hematology & Oncology Associates LTD
- North Mississippi Hospice, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
All providers in Tupelo, MS · Pediatrics Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.