NPIMap

Organization Active NPI

Family Health Center, Inc

  • Obstetrics & Gynecology Physician
  • Laurel, MS
National Provider Identifier
1003096785
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
FAMILY HEALTH CENTER, INC
Practice address
103 S. 12TH Avenue
Laurel, MS 39440
Phone
(601) 399-1970
Fax
(601) 399-2832
NPI assigned
Nov 9, 2007
Organization subpart
Yes
Parent organization
N/AAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Rashad N. Ali, M.D., J.D.NPI 1649297201
Title
Executive Director
Phone
(601) 425-3033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

103 S. 12TH Avenue
Laurel, MS 39440

Mailing address

P.O. Box 4361
Laurel, MS 39441-4361
Phone (601) 425-3033

Other names 1

  • OB / GYN Clinic at Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040414000267 MS Part B Supplier - Clinic/Group Practice 9638163348 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MS; Sandersville, MS; Taylorsville, MS; Waynesboro, MS
O20081119000589 MS Part A Provider - Federally Qualified Health Center (FQHC) 9638163348 Practice locations: Laurel, MS

Federally qualified health center certification: CCN 251980

Legal name
FAMILY HEALTH CENTER, INC
Doing business as
OB/GYN CLINIC AT FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2009
Last certification
Jan 6, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1986 in MS
Enrollment address
103 S 12TH Ave
Laurel, MS 39440-4322

All disclosed owners & managing parties 10

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
George Barnes Individual Corporate Director Nov 24, 2008
Kathryn Mizell Individual Corporate Director Nov 24, 2008
Randy Laird Individual Corporate Director Nov 24, 2008
Sherrin Roberts Individual W-2 Managing EmployeeCfo Apr 1, 2012
Barbara Pruitt Individual Corporate Director Nov 28, 2008
Coney Lee Johnson Individual Corporate OfficerCoo Apr 1, 2012
W-2 Managing Employee Apr 1, 2012
Rashad N Ali Individual Corporate OfficerCeo Aug 1, 2006
W-2 Managing Employee Oct 31, 2008
Joan Young Individual Corporate Director Nov 24, 2008
Trina Heidelberg Individual Corporate Director Nov 24, 2008
Lee Farmer Individual Corporate Director Nov 24, 2008

All facility ownership & control disclosures 1

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Health Center, Inc.Waynesboro, MS, CCN 251067 Federally qualified health center Other Aug 16, 1986

National Provider Directory

National Provider Directory
Tax ID family
Family Health Center10 organizations share this tax ID, including this one
Part of
Family Health Center

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

713 Lomax Ave
Waynesboro, MS 39367
Phone 6014253033157

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1003096785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4361",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394414361",
            "telephone_number": "601-425-3033",
            "fax_number": "601-422-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S. 12TH AVENUE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "39440",
            "telephone_number": "601-399-1970",
            "fax_number": "601-399-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "N/A",
        "enumeration_date": "2007-11-09",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "RASHAD",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-425-3033",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D., J.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OB / GYN Clinic at Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.