Covington County Hospital
Organization Active NPI Rural Health Clinic/Center · Seminary, MS
NPI 1134435498 · NPPES record last updated Aug 6, 2024
Key facts
- NPI
- 1134435498
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COVINGTON COUNTY HOSPITAL
- Practice address
- 104 W Main St
Seminary, MS 39479-9027 - Phone
- (601) 722-3610
- Fax
- (601) 722-9985
- NPI assigned
- Aug 25, 2010
- Organization subpart
- No
Authorized official
- Name
- Anissa L Evans
- Title
- Credentials
- Phone
- (601) 698-0328
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 15
Related certifications (CCN) 1
Practitioners 62
-
Lacey Blakeney, NP-C
-
Nadia Shanise Clark, FNP-C
-
Shelby Slade Dickerson, FNP-C
-
David Shane Johnson, PA-C
-
Nicole Lott, FNP-C
-
Crystal Parker McNabb, FNP-C
-
Vanessa Storozuk, APRN, FNP-C
-
Katie Daley Rush, CFNP
-
Twylia M. Aultman, FNP-C
-
Madelyn A Baucum, PA
-
Terri Bickham, FNP
-
Melissa Coulson, NP
-
Bria Goff, FNP-C, MPH
-
Christie Kellar, FNP-C
-
Ariale Marie Nelson, FNP-C
-
Ginger N Pace-Herndon, M.D.
-
Karen Renee Pitts, FNP
-
Felicia S Stewart, FNP
-
Terrie S Wilson, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2031642 | Family Care of Seminary | Provider-performed microscopy | Oct 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Rural health clinic certification: CCN 258561
- Legal name
- COVINGTON COUNTY HOSPITAL
- Doing business as
- FAMILY CARE OF SEMINARY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 23, 2012
- Last certification
- Jun 5, 2019
- Ownership / control type
- Non-profit – church related
- Organization structure
- Government · Non-profit
- Incorporated
- Jul 1, 1951 in MS
- Enrollment address
- 104 W Main St, Ste 20
Family Care of Seminary
Seminary, MS 39479-9027 - Related CCNs
- 251325
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Greg Sanford |
Corporate Director |
Jan 5, 2008 | 100% |
| James McPhail |
Corporate Director |
Jan 15, 2009 | 100% |
| Charlie Anglin |
Corporate Director |
Oct 8, 2007 | 100% |
| Robert Johnson |
Corporate Director |
Jan 23, 2007 | 100% |
| Greg Sullivan |
Corporate Director |
Oct 8, 2007 | 100% |
| Missy L Gamber |
Contracted Managing Employee |
Aug 1, 2014 | 100% |
| Gregg Gibbes |
Corporate Officer |
Apr 28, 2016 | 100% |
| W-2 Managing Employee |
Apr 28, 2016 | 100% | |
| Operational/Managerial Control |
Apr 28, 2016 | 100% | |
| Everlean Booth |
Corporate Director |
Nov 18, 2005 | 100% |
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Covington County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Jan 1, 2016 |
| Arrington Living Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 1, 2011 May 1, 2011 |
| Family Medical Associates |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2016 |
| Family Care Express |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2016 Jan 1, 2016 |
| CCH Clinic Magee |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 1, 2018 Mar 1, 2018 |
| Express Care Sumrall |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2020 |
| Family Care of Magee |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 4, 2021 Jan 4, 2021 |
| Family Care Magee Tuscan Towers |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 1, 2021 Sep 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110413000929 | MS | Part B Supplier - Clinic/Group Practice | 4183517253 |
Receives reassigned benefits from 26 practitioners Practice locations: Seminary, MS |
| O20111122000932 | MS | Part a Provider - Rural Health Clinic | 4183517253 | Practice locations: Seminary, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
104 W Main St
Seminary, MS 39479-9027
Mailing address
PO Box 2499
Collins, MS 39428-2499
Phone (601) 722-3610
Other names
- CCH Clinic Seminary
Other providers in Seminary, MS
- Logan J Berard
- Masey Blancett
- Linda Bond
- Megumi D. Boone
- Haleigh Marie Brown
- Mary Kathryn Dossett
- Hattiesburg Clinic PA
- Bobby G Jones
- Emily Key
- Lori Keys
All providers in Seminary, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.