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830 S Gloster St Tupelo MS 38801-4934 | |
| (662) 377-6533 | |
| (662) 377-3716 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 830 S Gloster St, Tupelo, Mississippi |
| Authorized Official Name and Position | Bruce Toppin (CORPORATE SECRETARY) |
| Authorized Official Contact | 6623774229 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
808 Varsity Dr Tupelo MS 38801-4613 Ph: (662) 377-2386 | 830 S Gloster St Tupelo MS 38801-4934 Ph: (662) 377-6533 |
| NPI Number | 1417357427 |
|---|---|
| Provider Enumeration Date | 08/27/2014 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Medicare PECOS PAC ID | 9931010600 |
|---|---|
| Medicare Enrollment ID | O20240426000582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417357427 | NPI | - | NPPES |
| 006953761 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Fermina Alia Pirmohamed |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508138314 PECOS PAC ID: 9133369754 Enrollment ID: I20201203002452 |
| Provider Name | William T Jackson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649706474 PECOS PAC ID: 6204105380 Enrollment ID: I20211015002303 |
| Provider Name | Khadija Irshad |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1528494689 PECOS PAC ID: 1153673462 Enrollment ID: I20240117004504 |
| Provider Name | Xiaohong Si |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801089347 PECOS PAC ID: 8921158833 Enrollment ID: I20240517000193 |
| Provider Name | Stephen Mcdonald |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093159444 PECOS PAC ID: 3779857735 Enrollment ID: I20240805004203 |
| Provider Name | Abhishek Achar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427400746 PECOS PAC ID: 6103185814 Enrollment ID: I20241115002680 |
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