North Mississippi Medical Center
Organization Active NPI Family Nurse Practitioner · Tupelo, MS
NPI 1255435905 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1255435905
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- NORTH MISSISSIPPI MEDICAL CENTER
- Practice address
- 806 Garfield St
Tupelo, MS 38801-5749 - Phone
- (662) 377-5395
- Fax
- (662) 377-5390
- NPI assigned
- Sep 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Bruce Toppin
- Title
- Corporate Secretary
- Phone
- (662) 377-4229
Corporate family (same tax ID) 24
Practitioners 10
-
William Brian Thomas, PSY.D.
-
Harry D. Marty Vigo, M.D.
-
Cheri Harbour, MS,OTR/L, SCLV
-
Malinda Prewitt, MD
-
Erin Smith, NURSE PRACTITIONER
-
Kellie Thornton, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2216852 | Garfield Clinic | Compliance | Apr 8, 2027 |
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
Locations
4381 S Eason Blvd
Ste 202
Tupelo, MS 38801
Phone (662) 377-6470
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
806 Garfield St
Tupelo, MS 38801-5749
Mailing address
808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-3204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CA5810 | Other | MS | RAILROAD MEDICARE |
| 009016203 | Medicaid | MS | |
| C02674 | Other | MS | MEDICARE GROUP NUMBER |
| CJ3596 | Other | MS | RAILROAD MEDICARE |
Other names
- Garfield Clinic
Other providers in Tupelo, MS
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medcial Center, Inc.
- North Mississippi Medical Center
- North Mississippi Medical Center
- North Mississippi Medical Center
- North Mississippi Medical Center
- North Mississippi Medical Center
- North Mississippi Medical Center
All providers in Tupelo, MS · Family Nurse Practitioner 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.