NPIMap

Organization Active NPI

Mid-State Health Systems, Inc

Doing business as My Place

  • Intellectual Disabilities Intermediate Care Facility
  • Fayetteville, NC
National Provider Identifier
1023450723
Registry record updated Dec 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-026-943 Issued in NC
Legal business name
MID-STATE HEALTH SYSTEMS, INC
Doing business as
My Place
Practice address
1050 Hogan St
Fayetteville, NC 28311-2340
Phone
(910) 484-3717
Fax
(910) 484-1315
NPI assigned
Jul 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2015

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

Authorized official

Name
Mrs. Sera Gilmore
Title
Administrator
Phone
(910) 484-3717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-026-943 NC Primary

Addresses

Primary practice location

1050 Hogan St
Fayetteville, NC 28311-2340

Mailing address

3721 Legion Rd
Hope Mills, NC 28348-8411
Phone (910) 484-3717

Other names 1

  • My Place Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mid-State Health Systems Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1023450723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 LEGION RD",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283488411",
            "telephone_number": "910-484-3717",
            "fax_number": "910-484-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 HOGAN ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283112340",
            "telephone_number": "910-484-3717",
            "fax_number": "910-484-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "GILMORE",
        "authorized_official_first_name": "SERA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-484-3717",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-026-943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.