Central Mississippi Civic Improvement Association, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Jackson, MS
NPI 1154424554 · NPPES record last updated Oct 25, 2018
Key facts
- NPI
- 1154424554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
- Practice address
- 3502 W Northside Dr
Jackson, MS 39213-4454 - Phone
- (601) 362-5321
- Fax
- (601) 364-2600
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jasmin O Chapman, DDS
- Title
- Ceo
- Phone
- (601) 364-5142
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 37
Practitioners 48
-
Ritha G Bookert, NP
-
Evelyn Winford Collier, D.M.D.
-
Stanitia W. Davis, D.P.M.
-
Latoya P. Johnson, PA-C
-
Linda Johnson, O.D.
-
Pamelia Watson-McGee, CFNP
-
Marie Evans Allen, FNP-C
-
Katrice Pacley Andrews, FNP-C
-
Sonya M Brown-Gibson, FNP
-
Felicia Brown, MD
-
Bethany Claire Bush, FNP-C
-
Patrecia Campbell, FNP-C
-
Geraldine Chaney, MD
-
Ava Christian, FNP-C
-
Candice Coleman, NP-C
-
Kim Cooper, NP
-
Kesha Major Flantroy, M.D.
-
Rita L Gordon, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040128000125 | MS | Part B Supplier - Clinic/Group Practice | 4183533235 |
Receives reassigned benefits from 70 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jackson, MS; Vicksburg, MS; Utica, MS; Edwards, MS; Hazlehurst, MS |
National Provider Directory
- Tax ID family
- Central Mississippi Improvement Association
Locations
550 Caldwell Dr
Hazlehurst, MS 39083
Phone (601) 894-1448
145 Raymond Rd
Jackson, MS 39204
Phone (601) 372-1800
7241 Gary Rd
Jackson, MS 39272
Phone (601) 373-1319
1311 W Pearl St
Jackson, MS 39203
Phone (601) 354-3346
514 E Woodrow Wilson Ave
Ste Ab
Jackson, MS 39216
Phone (601) 321-2234
260 Highway 18
Utica, MS 39175
Phone (601) 885-6021
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | MS | Yes |
Addresses
Primary practice location
3502 W Northside Dr
Jackson, MS 39213-4454
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00376796 | Medicaid | MS |
Other names
- Jackson-Hinds Comprehensive Health Center
Other providers in Jackson, MS
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
All providers in Jackson, 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 Oct 25, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.