Organization
NORTH MISSISSIPPI MEDICAL CENTER
Active
Other names
Sleep Lab
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD WAGES (COO)
(662) 377-3000
Entity
Organization
Contact information
Practice address
830 S GLOSTER ST, TUPELO, MS 38801-4934
(662) 377-4685
(662) 377-2755
Mailing address
PO BOX 4018, TUPELO, MS 38803-4018
(662) 377-4685
(662) 377-2755
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09420762
—
MS
01
—
C03168
MEDICARE GROUP NUMBER
MS
Enumeration date
09/28/2006
Last updated
08/03/2007
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