NPIMap

Organization Active NPI

Magnolia Regional Behavioral Health Services

  • Psychiatry Physician
  • Corinth, MS
National Provider Identifier
1033656889
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MAGNOLIA REGIONAL BEHAVIORAL HEALTH SERVICES
Practice address
611 Alcorn Dr
Corinth, MS 38834-9321
Phone
(662) 293-1000
NPI assigned
Jan 31, 2017
Last updated
Jan 23, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MAGNOLIA REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Authorized official

Name
Mr. Howard Nelson
Title
VP Physician Services
Phone
(662) 293-7618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

611 Alcorn Dr
Corinth, MS 38834-9321

Mailing address

401 Alcorn Dr Ste 2C
Corinth, MS 38834-9073
Phone (662) 293-7618

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170426001927 MS Part B Supplier - Clinic/Group Practice 3375820541 Receives reassigned benefits from 10 practitioners
Practice locations: Corinth, MS

National Provider Directory

National Provider Directory
Part of
Magnolia Regionl Health

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1033656889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ALCORN DR STE 2C",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349073",
            "telephone_number": "662-293-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 ALCORN DR",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349321",
            "telephone_number": "662-293-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA REGIONAL BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA REGIONAL HEALTH CENTER",
        "enumeration_date": "2017-01-31",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "662-293-7618",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corinth, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.