Basic Information
| Provider Information | |||||||||
| NPI: | 1891724035 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH MS EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3079 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392073079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667543852 | ||||||||
| FaxNumber: | 2053135245 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 S GLOSTER ST | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388014934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667543852 | ||||||||
| FaxNumber: | 2053135245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAMBERT | ||||||||
| AuthorizedOfficialFirstName: | BUFORD | ||||||||
| AuthorizedOfficialMiddleName: | LEWAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRIMARY ED PHYSICIAN CONTACT | ||||||||
| AuthorizedOfficialTelephone: | 6628427432 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 05352303 | 05 | MS | MEDICAID |