PANOLA PHYSICIAN GROUP, LLC (NPI# 1790385417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790385417 |
| Entity Type | Organization |
| Organization Name | PANOLA PHYSICIAN GROUP, LLC |
| Practice Address |
2089 Southridge Dr Tupelo MS 38801-6478 |
| Mailing Address |
303 Medical Center Dr Batesville MS 38606-8608 |
| Practice Telephone | 6624070801 |
| Mailing Telephone | 6625635611 |
| Mailing Fax Number | 6625630155 |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | MR. ROBERT QUENTIN WHITWELL (CEO) |
| Authorized Official Telephone | 6627019346 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP3300X |
Clinic/Center Specialization: Pain |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Pain Management Center of North Mississippi | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528528874 | Panola Physician Group, LLC | Family Medicine | 223 E Main St, Senatobia, MS 38668-2123 | 2019-03-22 |
| Street Address |
2089 SOUTHRIDGE DR |
| City | TUPELO |
| State | MS |
| Zip Code | 38801-6478 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578560538 | George Monroe Hammitt IIi | Anesthesiology | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2005-07-06 |
| 1346754793 | Holly Corbin Poland | Nurse Practitioner | 2089 Southridge Dr, Tupelo, MS 38801 | 2017-11-21 |
| 1871892570 | Holly J Kendrick | Nurse Practitioner | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2011-03-21 |
| 1083858229 | Jennifer L Rodabough | Physical Therapist | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2009-04-30 |
| 1861639015 | Katherine B Thomas | Nurse Practitioner | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2009-01-09 |
| 1255584173 | Rita Testa Ragan | Nurse Practitioner | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2008-10-23 |
| 1811928724 | Pain Management Center of North | Clinic/Center | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1003443458 | Nicole Sherice Taylor | Nurse Practitioner | 845 South Gloster Street, Tupelo, MS 38801 | 2020-03-25 |
| 1821556838 | Wilco Healthcare of North Mississippi, Pllc | Point of Service | 1514 Co Rd 41, Tupelo, MS 38801 | 2019-03-08 |
| 1821565235 | Stephanie K Cagle | Nurse Practitioner | 218 S Thomas St Ste 120-121, Tupelo, MS 38801 | 2018-10-24 |
| 1073092326 | Lauren Parrish | Nurse Practitioner | 1573 Medical Park Circle, Tupelo, MS 38801 | 2018-08-08 |
| 1467948687 | North Mississippi Medcial Center, Inc. | Nurse Practitioner | 990 S Madison St Ste 2, Tupelo, MS 38801 | 2018-07-11 |
| 1043700933 | Hooks Diabetes & Medicine Clinic | Non-Pharmacy Dispensing Site | 2610 Traceland Drive, Ste A, Tupelo, MS 38801 | 2018-05-16 |
| 1073035903 | Annette C Riddle | Counselor | 1004 Eisenhower Drive, Tupelo, MS 38801 | 2017-07-12 |
| 1548709678 | Jaime Summers | Nurse Practitioner | 2780 West Jackson St, Tupelo, MS 38801 | 2017-02-22 |
| 1073975611 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 1168 Cross Creek Drive, Tupelo, MS 38801 | 2016-03-23 |
| Find all providers in zip 38801 | ||||
| Taxonomy Code | 261QP3300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Pain |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811928724 | Pain Management Center of North | Clinic/Center | 2089 Southridge Dr, Tupelo, MS 38801-6478 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104300854 | Willow Pain and Wellness, LLC | Clinic/Center | 255 Medical Center Dr., Batesville, MS 38606 | 2018-09-19 |
| 1679096192 | Neuromodulation Specialists LLC | Clinic/Center | 4105 Hospital St # 112c, Pascagoula, MS 39581-5312 | 2017-07-18 |
| 1265527899 | Methodist Pain Management, LLC | Clinic/Center | One Layfair Dr, Suite 400, Jackson, MS 39232 | 2006-10-03 |
| 1710929310 | Trinity Pain Clinic, P.a. | Clinic/Center | 1307 Airport Rd N, Suite 2a, Flowood, MS 39232-8897 | 2006-06-11 |
| 1093188096 | Willow Pain and Wellness, LLC | Clinic/Center | 2215 Jefferson Davis Dr, Oxford, MS 38655-5221 | 2015-11-12 |
| 1639583941 | Comprehensive Pain Specialists | Clinic/Center | 120 Stone Creek Blvd, Flowood, MS 39232-8205 | 2014-06-13 |
| 1336408186 | Premier Pain Care, P.C. | Clinic/Center | 514f E Woodrow Wilson Ave, Jackson, MS 39216-4538 | 2012-05-15 |
| 1770743031 | Newsouth Neurospine, LLC | Clinic/Center | 2470 Flowood Dr, Flowood, MS 39232-9019 | 2008-06-11 |
| 1174689533 | Pain Treatment Center | Clinic/Center | 106 Asbury Cir, Hattiesburg, MS 39402-1302 | 2006-12-29 |
| 1508922865 | Institute for Spinal Pain Treatment | Clinic/Center | 1 Lincoln Parkway, Suite 106, Hattiesburg, MS 39402 | 2006-12-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.