NPIMap

Organization Active NPI

George Regional ER Physicians

  • Emergency Medical Services (Emergency Medicine) Physician
  • Lucedale, MS
National Provider Identifier
1043690936
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
Legal business name
GEORGE REGIONAL ER PHYSICIANS
Practice address
859 Winter St
Lucedale, MS 39452-6603
Phone
(601) 947-3161
Fax
(601) 947-1331
NPI assigned
Jun 4, 2015
Last updated
Nov 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Authorized official

Name
Ms. Kathy Fender
Title
Administrator
Phone
(601) 947-8181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0004X Primary

Addresses

Primary practice location

859 Winter St
Lucedale, MS 39452-6603

Mailing address

PO Box 1007
Lucedale, MS 39452-1007
Phone (601) 947-1332

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150728006195 MS Part B Supplier - Clinic/Group Practice 6608180138 Receives reassigned benefits from 34 practitioners
Practice locations: Lucedale, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1043690936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1007",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394521007",
            "telephone_number": "601-947-1332",
            "fax_number": "601-947-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 WINTER ST",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394526603",
            "telephone_number": "601-947-3161",
            "fax_number": "601-947-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE REGIONAL ER PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "FENDER",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-947-8181",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lucedale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; 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.