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4579 S Eason Blvd Ste A Tupelo MS 38801-6539 | |
| (662) 377-7590 | |
| (662) 377-7595 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4579 S Eason Blvd Ste A, Tupelo, Mississippi |
| Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
| Authorized Official Contact | 6623774229 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
808 Varsity Dr Tupelo MS 38801-4613 Ph: (662) 377-2386 | 4579 S Eason Blvd Ste A Tupelo MS 38801-6539 Ph: (662) 377-7590 |
| NPI Number | 1730295585 |
|---|---|
| Provider Enumeration Date | 08/22/2006 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730295585 | NPI | - | NPPES |
| CJ3596 | Other | MS | RAILROAD MEDICARE |
| CA5810 | Other | MS | RAILROAD MEDICARE |
| 009015827 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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