Provider Demographics
NPI:1154533321
Name:CARDIOTHORACIC SURGERY CLINIC OF NORTH MS
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGERY CLINIC OF NORTH MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:TALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-377-7170
Mailing Address - Street 1:PO BOX 7062
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-7062
Mailing Address - Country:US
Mailing Address - Phone:662-377-7170
Mailing Address - Fax:662-377-2423
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-377-7170
Practice Address - Fax:662-377-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09019082Medicaid
MSC02453Medicare ID - Type Unspecified