NPIMap

Organization Active NPI

Midsouth Transitions Arkansas PA

  • Internal Medicine Physician
  • Texarkana, AR
National Provider Identifier
1003427873
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MIDSOUTH TRANSITIONS ARKANSAS PA
Practice address
6010 Trinity HTS
Texarkana, AR 71854-8318
Phone
(430) 200-4350
Fax
(833) 491-2722
NPI assigned
Aug 13, 2020
Last updated
Nov 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Coy WilliamsonNPI 1770048324
Title
Coo
Phone
(430) 200-4350

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

6010 Trinity HTS
Texarkana, AR 71854-8318

Mailing address

5904 Summerfield Dr
Texarkana, TX 75503-4306
Phone (430) 200-4350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201103002747 AR Part B Supplier - Clinic/Group Practice 1153731005 Receives reassigned benefits from 17 practitioners
Practice locations: Texarkana, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2290838Midsouth Transitions Arkansas PA6010 Trinity HTS, Texarkana, AR 71854Certificate of waiverOct 1, 2027

National Provider Directory

National Provider Directory

Locations

3002 Moores Ln
Texarkana, TX 75503
Phone (430) 200-0435

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1003427873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5904 SUMMERFIELD DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755034306",
            "telephone_number": "430-200-4350",
            "fax_number": "866-337-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 TRINITY HTS",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718548318",
            "telephone_number": "430-200-4350",
            "fax_number": "833-491-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH TRANSITIONS ARKANSAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "COY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "430-200-4350"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.