Active NPI
North Mississippi State Hospital
- Psychiatric Hospital
- Tupelo, MS
National Provider Identifier
1114054301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Hospital
- License
- 31328
- Legal business name
- NORTH MISSISSIPPI STATE HOSPITAL
- Practice address
- 1937 Briar Ridge Rd
Tupelo, MS 38804-5963 - Phone
- (662) 690-4200
- Fax
- (662) 690-4227
- NPI assigned
- Feb 27, 2007
- Last updated
- Mar 11, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Miss Paul A Callens
- Title
- Facility Director
- Phone
- (662) 690-4200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital | 283Q00000X | 31328 | MS | Primary |
Addresses
Primary practice location
1937 Briar Ridge Rd
Tupelo, MS 38804-5963
Mailing address
1937 Briar Ridge Rd
Tupelo, MS 38804-5963
Phone (662) 690-4200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110310000998 | MS | Part A Provider - Hospital | 4082896105 | Practice locations: Tupelo, MS |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1114054301. Details of each certification follow.
Hospital certification: CCN 254009
- Legal name
- NORTH MISSISSIPPI STATE HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Psychiatric
- Participating since
- May 8, 2002
- Last certification
- Apr 8, 2010
- Beds
- 82
- Ownership / control type
- State
- Organization structure
- Government
- Enrollment address
- 1937 Briar Ridge Road
Tupelo, MS 38804-5963 - Hospital subgroups
- Psychiatric
Care Compare: Hospital
Medicare Care Compare- Listed as
- North Mississippi State Hospital
- Type
- Psychiatric
- Ownership
- Government - State
- Medicare certification status
- Active
- Emergency services
- No
National Provider Directory
National Provider Directory- Tax ID family
- North Mississippi State Hospital
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Institutional Pharmacy
- Tupelo, MS
- NPI 1194850917
Ownership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Paul Callens | Corporate Director | May 8, 2002 | |
| W-2 Managing Employee | May 8, 2002 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1299801600000",
"number": "1114054301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1937 BRIAR RIDGE RD",
"city": "TUPELO",
"state": "MS",
"postal_code": "388045963",
"telephone_number": "662-690-4200",
"fax_number": "662-690-4227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1937 BRIAR RIDGE RD",
"city": "TUPELO",
"state": "MS",
"postal_code": "388045963",
"telephone_number": "662-690-4200",
"fax_number": "662-690-4227"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTH MISSISSIPPI STATE HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-27",
"last_updated": "2011-03-11",
"status": "A",
"authorized_official_last_name": "CALLENS",
"authorized_official_first_name": "PAUL",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "FACILITY DIRECTOR",
"authorized_official_telephone_number": "662-690-4200",
"authorized_official_name_prefix": "Miss"
},
"taxonomies": [
{
"code": "283Q00000X",
"taxonomy_group": "",
"desc": "Psychiatric Hospital",
"state": "MS",
"license": "31328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
- North Mississippi Oral & Maxillofacial Surgery Associates, PA
- North Mississippi Orthodontic Associates PA
- North Mississippi Pain Management Center
- North Mississippi Pediatrics PA
- North Mississippi Periodontics & Implant Dentistry PLLC
- North Mississippi State Hospital Pharmacy
- North Mississippi Vascular Center, PA
- North Ms Emergency Physicians
- Northeast Community Services
- Northeast Mental Health-Mental Retardation Commission (Lifecore Pharmacy Tupelo)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.