Provider Demographics
NPI:1912738469
Name:NORTHWEST MISS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:NORTHWEST MISS REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-624-3480
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-0340
Mailing Address - Country:US
Mailing Address - Phone:662-624-3480
Mailing Address - Fax:
Practice Address - Street 1:802 E SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2824
Practice Address - Country:US
Practice Address - Phone:662-627-7362
Practice Address - Fax:662-627-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty