NPIMap

Organization Active NPI

Ellisville State School

  • Technician
  • Ellisville, MS
National Provider Identifier
1164582821
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
TechnicianTaxonomy code 374700000X
License
ESS-BMR Issued in MS
Legal business name
ELLISVILLE STATE SCHOOL
Practice address
1101 Highway 11 S
Ellisville, MS 39437-4443
Phone
(601) 477-9384
Fax
(601) 477-5700
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Dr. Suzie Lassiter
Title
Director of Facility
Phone
(601) 477-9384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 374700000X ESS-BMR MS Primary

Addresses

Primary practice location

1101 Highway 11 S
Ellisville, MS 39437-4443

Mailing address

1101 Highway 11 S
Ellisville, MS 39437-4443
Phone (601) 477-9384

Other identifiers 1

IdentifierTypeStateIssuer
09015542MedicaidMS

Other names 1

  • EPSDT Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ellisville State School9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1164582821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HIGHWAY 11 S",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394374443",
            "telephone_number": "601-477-9384",
            "fax_number": "601-477-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HIGHWAY 11 S",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394374443",
            "telephone_number": "601-477-9384",
            "fax_number": "601-477-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISVILLE STATE SCHOOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "LASSITER",
        "authorized_official_first_name": "SUZIE",
        "authorized_official_title_or_position": "DIRECTOR OF FACILITY",
        "authorized_official_telephone_number": "601-477-9384",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician",
            "state": "MS",
            "license": "ESS-BMR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015542",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EPSDT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellisville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.