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4579 S Eason Blvd Tupelo MS 38801-6539 | |
| (662) 377-3000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 4579 S Eason Blvd, 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) 377-2774 | 4579 S Eason Blvd Tupelo MS 38801-6539 Ph: (662) 377-3000 |
| NPI Number | 1265549646 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 01/21/2025 |
| Certification Date | 01/21/2025 |
| Medicare PECOS PAC ID | 9931010600 |
|---|---|
| Medicare Enrollment ID | O20080428000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265549646 | NPI | - | NPPES |
| 004000857 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 13-063 (Mississippi) | Primary |
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