North Mississippi Medical Center
Organization Active NPI Surgery Physician · Tupelo, MS
NPI 1295932853 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1295932853
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- License
- 12874 (MS)
- Legal business name
- NORTH MISSISSIPPI MEDICAL CENTER
- Practice address
- 499 Gloster Creek VLG Ste S-2
Tupelo, MS 38801-4600 - Phone
- (662) 377-7546
- Fax
- (662) 377-6330
- NPI assigned
- Jun 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Bruce Toppin
- Title
- Corporate Secretary
- Phone
- (662) 377-4229
Corporate family (same tax ID) 24
Practitioners 15
-
Santrise Goree, M.D.
-
Mark H. Fletcher, M.D.
-
Samuel D. Newell Jr., M.D.
-
Erin Smith, NURSE PRACTITIONER
-
Kellie Thornton, NP
-
Hollie Waldron, NP
-
Angela Christine Middleton, FNP-BC, CEN
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
408 Council Cir
Tupelo, MS 38801
Phone (601) 841-7585
408 Council Cir
Ste C
Tupelo, MS 38801
Phone (662) 377-3376
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | 12874 | MS | Yes |
Addresses
Primary practice location
499 Gloster Creek VLG Ste S-2
Tupelo, MS 38801-4600
Mailing address
808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-2386
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003135025 | Medicaid | MS |
Other names
- Bariatric Clinic
Other providers in Tupelo, MS
- 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
- North Mississippi Medical Center
- North Mississippi Medical Center
All providers in Tupelo, MS · Surgery 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.