Laird Hospital, Inc.
Organization Active NPI Rural Health Clinic/Center · Decatur, MS
NPI 1033460878 · NPPES record last updated Apr 26, 2023
Key facts
- NPI
- 1033460878
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- LAIRD HOSPITAL, INC.
- Practice address
- 14884 Highway 15
Decatur, MS 39327 - Phone
- (601) 635-2258
- Fax
- (601) 635-2259
- NPI assigned
- Sep 19, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Don Larkin Kennedy
- Title
- Regional Ceo
- Phone
- (601) 703-9614
Owners & managing parties with NPI records 3
-
Johnathan Lee, M.D.
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 8
Member of 1
Facilities with the same owner 75
Practitioners 32
-
Krista L. Boyette, M.D.
-
Sierra Cain, NP-C
-
Andrew Daughton Chambers, FNP-BC
-
Tiffany Dearman, FNP
-
Jessica Derrick, FNP-C
-
Patrick Eakes, MD
-
Brelan Mikal Gardner, FNP
-
Patsy Lenan Holloway, FNP BC
-
Anita Mathews Lee, LPC, NBCC, NBSC
-
Betsy L Mann, FNP
-
Morgan Lee McClure, FNP-C
-
Bobbie Evans Mooney, APRN
-
Rhonda Moore, AGPCNP-BC
-
Kristin Taylor Peterson, FNP-C
-
Lasaundra Roberts, APMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Rural health clinic certification: CCN 258505
- Legal name
- LAIRD HOSPITAL, INC.
- Doing business as
- OCHSNER HEALTH CENTER- DECATUR
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 16, 2002
- Last certification
- Oct 22, 2019
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 3, 2004 in MS
- Enrollment address
- 14884 Highway 15
Decatur, MS 39327-9697
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Johnathan Y Lee |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Michael F Hulefeld |
Corporate Officer |
Nov 1, 2022 | |
| Corporate Director |
Nov 1, 2022 | ||
| Operational/Managerial Control |
Nov 1, 2022 | ||
| Faye Martin |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Alan Gartrell |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Peter C November |
Corporate Officer |
Nov 1, 2022 | |
| Corporate Director |
Nov 1, 2022 | ||
| Operational/Managerial Control |
Nov 1, 2022 | ||
| Heather Davis |
W-2 Managing Employee | Jan 1, 2024 | |
| Operational/Managerial Control | Jan 1, 2024 | ||
| James M Molloy |
Corporate Officer | Jan 1, 2024 | |
| Darrell Wildman |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Ochsner Clinic Foundation |
5% Or Greater Indirect Ownership Interest | Jul 1, 2022 | 100% |
| Operational/Managerial Control | Jul 1, 2022 | ||
| Don L Kennedy |
Corporate Officer |
Jul 1, 2022 | |
| W-2 Managing Employee |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Rush Health Systems Inc |
5% Or Greater Direct Ownership Interest | Jul 1, 2022 | 100% |
| Operational/Managerial Control | Nov 1, 2012 | ||
| David L Butler |
Corporate Officer |
Jan 1, 2020 | |
| W-2 Managing Employee |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050201000304 | MS | Part B Supplier - Clinic/Group Practice | 7214991769 |
Receives reassigned benefits from 106 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Collinsville, MS; Union, MS; Philadelphia, MS; Meridian, MS; Newton, MS; Decatur, MS |
| O20130814000278 | MS | Part a Provider - Rural Health Clinic | 7214991769 | Practice locations: Decatur, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
14884 Highway 15
Decatur, MS 39327
Mailing address
Dept. 3023 PO Box 1000
Memphis, TN 38148-3023
Phone (601) 213-3010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002276065 | Medicaid | MS |
Other names
- Ochsner Health Center- Decatur
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Decatur, MS
- Hopecrest Mental Health Services, LLC
- Derrick Wesley Jones
- Kalena Smith
- Brandi B Keith
- Laboratory Corporation of America Holdings
- Julie Clanton Mangum
- Cynthia B. Massey
- Natalie Boggan May
- Kristin Lynne McDonald
- Deborah Allean Miller
All providers in Decatur, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.