Provider Demographics
NPI:1255873873
Name:NORTHEAST MISSISSIPPI INPATIENT SERVICES, LLC
Entity type:Organization
Organization Name:NORTHEAST MISSISSIPPI INPATIENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-554-9252
Mailing Address - Street 1:202 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-2718
Mailing Address - Country:US
Mailing Address - Phone:662-340-1138
Mailing Address - Fax:662-728-5185
Practice Address - Street 1:202 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2718
Practice Address - Country:US
Practice Address - Phone:662-340-1138
Practice Address - Fax:662-728-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center