Greater Meridian Health Clinic, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Meridian, MS
NPI 1053046201 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1053046201
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GREATER MERIDIAN HEALTH CLINIC, INC
- Practice address
- 2701 Davis St
Meridian, MS 39301-5708 - Phone
- (601) 693-0118
- Fax
- (844) 778-8922
- NPI assigned
- Jul 21, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- GREATER MERIDIAN HEALTH CLINIC, INC.
Authorized official
- Name
- Wilbert Jones
- Title
- Ceo
- Phone
- (601) 693-0118
Owners & managing parties with NPI records 9
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 10
Facilities with the same owner 4
Practitioners 23
-
Latorya Barron, NP
-
Nacara S Grayson, APRN-FNP-C
-
Britney Deon Kersh, FNP-C
-
Roger L Nunez, MD
-
Tiffany Alyssa Roulier, FNP-C
-
Urelaine R Simon - Hart, M.D.
-
Candace Pringle-Welch, FNP, CNM
-
Tanyaneka Wilson, FNP-BC
-
Jalisha Brown, FNP-C
-
Jonathan J Bruno, MD
-
Gwendolyn Denise Burnside, FNP-C
-
Sandra Denice Clark, ED.S
-
Lajaysha Echoles, FNP-BC
-
Joanne Haynes, NP
-
Mattie P Hopson, MSN, APRN, FNP-C
-
Denise R. Ruffin, DDS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Federally qualified health center certification: CCN 251137
- Legal name
- GREATER MERIDIAN HEALTH CLINIC, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 12, 2022
- Last certification
- Sep 12, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 10, 2022 in MS
- Enrollment address
- 2701 Davis St
Meridian, MS 39301-5708
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Ronald Turner |
Corporate Officer |
Mar 10, 2022 | |
| Kathi Wilson |
Corporate Officer |
Mar 10, 2022 | |
| Gwendolyn Hughes |
Corporate Officer |
Mar 10, 2022 | |
| Tonya M Hunt |
Corporate Director |
Mar 10, 2022 | |
| Eugene Boger |
Corporate Director |
Mar 10, 2022 | |
| John McClure |
Corporate Director |
Mar 10, 2022 | |
| Deborah Todd |
Corporate Director |
Mar 10, 2022 | |
| Latoria Brown |
Corporate Director |
Mar 10, 2022 | |
| David M Carter |
Corporate Director |
Mar 10, 2022 | |
| Jimmie Smith |
Corporate Director |
Mar 10, 2022 | |
| Michelle Stewart |
Corporate Officer |
Mar 10, 2022 | |
| Wilbert L. Jones |
Corporate Officer |
Mar 10, 2022 | |
| Operational/Managerial Control |
Mar 10, 2022 | ||
| Lisa Silliman |
Corporate Director |
Mar 10, 2022 | |
| Melvin R Robinson |
Corporate Director |
Mar 10, 2022 | |
| Laura Carmichael |
Corporate Director |
Mar 10, 2022 | |
| Dede Mogollon |
Corporate Officer |
Mar 10, 2022 | |
| Greater Meridian Health Clinic, Inc. |
Operational/Managerial Control | Oct 1, 1986 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Oktibbeha Family Medical Clinic |
Federally qualified health center | Operational/Managerial Control | Oct 6, 2003 |
| Shuqualak-Noxubee Health Clinic |
Federally qualified health center | Operational/Managerial Control | Aug 1, 1987 |
| GMHC, Inc./MPSD West End/T J Harris Community School Base Clinic |
Federally qualified health center | Operational/Managerial Control | Nov 16, 2017 |
| GMHC, Inc./MPSD Meridian High School Community School Based Clinic |
Federally qualified health center | Operational/Managerial Control | May 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040217000471 | MS | Part B Supplier - Clinic/Group Practice | 9032027834 |
Receives reassigned benefits from 16 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Meridian, MS; Starkville, MS; Scooba, MS; Macon, MS; Louisville, MS; Dekalb, MS |
| O20220928001310 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 9032027834 | Practice locations: Meridian, MS |
National Provider Directory
- Tax ID family
- Greater Meridian Health
- Part of
- Greater Meridian Health
Locations
14130 Highway 15 S
Ste D
Louisville, MS 39339
Phone (662) 779-1175
199 Highway 15 S
#D
Louisville, MS 39339
Phone (662) 779-1175
2640 24th Ave
Rm L135
Meridian, MS 39305
Phone (601) 693-0118
900 44th Ave
Meridian, MS 39307
Phone (601) 482-9837
900 44th Ave
#G
Meridian, MS 39307
Phone (601) 693-0118
67 Mulberry St
Shuqualak, MS 39361
Phone (662) 793-4845
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EJDBBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2701 Davis St
Meridian, MS 39301-5708
Mailing address
2701 Davis St
Meridian, MS 39301-5708
Phone (601) 693-0118
Other names
- GMHC Mobile Access Unit 2
Other providers in Meridian, MS
- Kaitlyn Gray
- Leslie B. Gray
- Talmadge Rhodes Gray
- Grayson Optical Inc.
- Nacara S Grayson
- Greater Meridian Health Clinic, Inc
- Greater Meridian Health Clinic, Inc.
- Greater Meridian Health Clinic, Inc.
- Greater Meridian Health Clinic, Inc.
- Greater Meridian Health Clinic, Inc.
All providers in Meridian, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. 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.