Provider Demographics
NPI:1073347084
Name:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Entity type:Organization
Organization Name:NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARDEE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-502-3149
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-0092
Mailing Address - Country:US
Mailing Address - Phone:662-502-3149
Mailing Address - Fax:
Practice Address - Street 1:15931 BOUNDARY DRIVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603
Practice Address - Country:US
Practice Address - Phone:662-502-3149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)