NPIMap

Organization Active NPI

Mizell Memorial Hospital, Inc.

  • Rural Acute Care Hospital
  • Opp, AL
National Provider Identifier
1013937705
Registry record updated Dec 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
11789 Issued in AL
Legal business name
MIZELL MEMORIAL HOSPITAL, INC.
Practice address
702 N Main St
Opp, AL 36467-1626
Phone
(334) 493-3541
Fax
(334) 493-9433
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2019

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

Authorized official

Name
Mrs. Jana Wyatt, CPA
Title
Chief Executive Officer
Phone
(334) 493-9111

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Lithotripsy Clinic/Center 261QL0400X
Psychiatric Hospital Unit 273R00000X AL
Medicare Defined Swing Bed Hospital Unit 275N00000X AL
Rural Acute Care Hospital 282NR1301X 11789 AL Primary

Addresses

Primary practice location

702 N Main St
Opp, AL 36467-1626

Mailing address

PO Box 1010
Opp, AL 36467-1010
Phone (334) 493-3541

Other identifiers 2

IdentifierTypeStateIssuer
HOS0007HMedicaidAL
010095OtherALBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20051220000136 AL Part B Supplier - Clinic/Group Practice 6507820990 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
Practice locations: Opp, AL
O20080521000144 AL Part A Provider - Hospital 6507820990 Practice locations: Opp, AL
O20080922000250 AL Part A Provider - Hospital 6507820990 Practice locations: Opp, AL
O20080923000617 AL Part A Provider - Hospital 6507820990 Practice locations: Opp, AL

Hospital certification: CCN 01U007

Legal name
MIZELL MEMORIAL HOSPITAL, INC.
Organization structure
CorporationNon-profit
Incorporated
Nov 29, 1945 in AL
Enrollment address
702 N Main Street
Opp, AL 36467-1626
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Hospital certification: CCN 010007

Legal name
MIZELL MEMORIAL HOSPITAL, INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 12, 2024
Beds
99
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1945 in AL
Enrollment address
702N Main St
Opp, AL 36467-1626
Main/Primary Hospital Location
Hospital subgroups
Acute care, Swing-bed approved, Psychiatric unit

Hospital certification: CCN 01S007

Legal name
MIZELL MEMORIAL HOSPITAL, INC.
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1945 in AL
Enrollment address
702N Main St
Opp, AL 36467-1626
Hospital Psychiatric Unit
Hospital subgroups
Acute care, Psychiatric, Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mizell Memorial HospitalCCN 010007
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

103 E Memorial Ave
Opp, AL 36467
Phone (334) 493-0606

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
John Adams Individual Corporate DirectorBoard of Directors Jun 28, 2011
Timothy Loggins Individual Corporate DirectorBoard of Directors, Secretary Mar 1, 1995
Frank L McGuire Individual Corporate DirectorBoard of Directors Mar 1, 2001
Jonathan M Stanfield Individual Corporate DirectorBoard of Directors Aug 23, 2011
Melinda Hall Individual Corporate DirectorBoard of Directors Sep 1, 2012
Skipper Spurlin Individual Corporate DirectorBoard of Directors Sep 1, 2012
Jana Wyatt Individual W-2 Managing EmployeeCfo Jan 1, 2010
W-2 Managing EmployeeCeo Jan 1, 2010
Mizell Memorial Hospital, Inc. Organization, Opp, AL Non-profit Other Nov 29, 1945
Jeffrey Harold Worley Individual Corporate DirectorBoard of Directors, Vice-Chairman Sep 16, 2008
Kenneth J Crowe Individual Corporate DirectorBoard of Directors Jan 1, 2012
Amy Bess Individual W-2 Managing EmployeeCfo Jan 1, 2010
Aaron Hightower Individual Corporate DirectorBoard of Directors Dec 15, 2009
Robert D Breedlove Individual Corporate DirectorBoard of Directors, Chairman Oct 20, 1981

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
LHC Homecare of South AlabamaOpp, AL, CCN 017134 Home health agency 5% Or Greater Direct Ownership Interest (10%) Jan 17, 2005

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

Affiliated clinicians 88

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577145600000",
    "number": "1013937705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "OPP",
            "state": "AL",
            "postal_code": "364671010",
            "telephone_number": "334-493-3541",
            "fax_number": "334-493-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N MAIN ST",
            "city": "OPP",
            "state": "AL",
            "postal_code": "364671626",
            "telephone_number": "334-493-3541",
            "fax_number": "334-493-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIZELL MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "334-493-9111",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QL0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Lithotripsy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "AL",
            "license": "11789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HOS0007H",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "010095",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Opp, AL

Sources for this page

Verify at the official NPI Registry.