NPIMap

Organization Active NPI

Pontotoc Health Services, Inc.

Doing business as Chickasaw Medical Clinic

  • Rural Health Clinic/Center
  • Houston, MS
National Provider Identifier
1073920328
Registry record updated Sep 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
16091 Issued in MS
Legal business name
PONTOTOC HEALTH SERVICES, INC.
Doing business as
Chickasaw Medical Clinic
Practice address
208 Country Club Rd
Houston, MS 38851-9326
Phone
(662) 456-3437
NPI assigned
Jul 18, 2014
Last updated
Sep 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2014

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

Authorized official

Name
Mr. Joseph A Reppert
Title
Cfo
Phone
(662) 377-3978

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 16091 MS Primary

Addresses

Primary practice location

208 Country Club Rd
Houston, MS 38851-9326

Mailing address

176 S Main St
Pontotoc, MS 38863-3311
Phone (662) 489-5510

Other names 1

  • Chickasaw Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pontotoc Health Providers11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

208 Country Club Rd
Houston, MS 38851
Phone (662) 456-3437

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409702400000",
    "number": "1073920328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 S MAIN ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388633311",
            "telephone_number": "662-489-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 COUNTRY CLUB RD",
            "city": "HOUSTON",
            "state": "MS",
            "postal_code": "388519326",
            "telephone_number": "662-456-3437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTOTOC HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-09-03",
        "status": "A",
        "authorized_official_last_name": "REPPERT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "662-377-3978",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "16091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chickasaw Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; 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.