Organization
NORTH MISSISSIPPI MEDICAL CENTER
Active
Other names
Glycemic Control Center
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD WAGES (TREASURER)
(662) 377-3000
Entity
Organization
Contact information
Practice address
830 S GLOSTER ST, 1ST FLOOR EAST TOWER, TUPELO, MS 38801-4934
(662) 377-2500
(662) 377-2069
Mailing address
450 E PRESIDENT AVE, TUPELO, MS 38801-5599
(662) 377-4685
(662) 377-2755
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03168
MEDICARE GROUP
MS
Enumeration date
11/01/2007
Last updated
11/01/2007
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