Mallory Community Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MALLORY COMMUNITY HEALTH

Practice address

3877 Highway 51
Goodman, MS 39079-9588

Phone

(662) 468-2116

NPI assigned

Jul 22, 2016

Last updated

Jul 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Clyde Rozell Chapman, MD

Title

Chief Executive Officer

Phone

(662) 834-2566

Specialties & licenses 1

Addresses

Other names 1

• Dr. Arenia C. Mallory Community Health Center, Inc. Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104279355. Details of each certification follow.

• CCN 251058 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 251058

Legal name

MALLORY COMMUNITY HEALTH

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 22, 2017

Last certification

Aug 22, 2017

Ownership / control type

For profit – corporation

Facility address

3877 Highway 51
Goodman, MS 39079

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469145600000",
    "number": "1104279355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 479",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390950479",
            "telephone_number": "662-834-1857",
            "fax_number": "662-834-1859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3877 HIGHWAY 51",
            "city": "GOODMAN",
            "state": "MS",
            "postal_code": "390799588",
            "telephone_number": "662-468-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLORY COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-22",
        "last_updated": "2016-07-22",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "ROZELL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "662-834-2566",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Arenia C. Mallory Community Health Center, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Katherine Suzanne Bailey, MS, CCC-SLP
• Harry Albert Bartee Sr., MD
• Bearing Tree Creek Consulting, LLC
• G a Carmichael Family Health Center, Inc.
• Roneda Denise Lowe, M.S.,CCC-SLP

• Federally Qualified Health Center (FQHC) in Goodman, MS
• Providers in Goodman, MS by specialty
• Federally Qualified Health Center (FQHC) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.