NPIMap

Organization Active NPI

South Central Regional Medical Center

Doing business as OB Gyn Associates

  • Obstetrics & Gynecology Physician
  • Laurel, MS
National Provider Identifier
1174562979
Registry record updated Dec 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing business as
OB Gyn Associates
Practice address
203 S 12TH Ave
Laurel, MS 39440
Phone
(601) 426-6961
Fax
(601) 426-3449
NPI assigned
Jun 6, 2006
Last updated
Dec 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2007

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

Authorized official

Name
Mr. John Chioco, MSHA
Title
Associate Executive Director
Phone
(601) 426-4501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

203 S 12TH Ave
Laurel, MS 39440

Mailing address

PO Box 1649
Laurel, MS 39441-1649
Phone (601) 426-6961

Other identifiers 1

IdentifierTypeStateIssuer
09016136MedicaidMS

Other names 1

  • OB Gyn Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000259 MS Part B Supplier - Clinic/Group Practice 8325946411 Receives reassigned benefits from 17 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MS

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199059200000",
    "number": "1174562979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1649",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394411649",
            "telephone_number": "601-426-6961",
            "fax_number": "601-426-3449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S 12TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "39440",
            "telephone_number": "601-426-6961",
            "fax_number": "601-426-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-12-31",
        "status": "A",
        "authorized_official_last_name": "CHIOCO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ASSOCIATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-426-4501",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSHA"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016136",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OB Gyn Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.