NPIMap

Organization Active NPI

Mississippi Methodist Hospital & Rehabilitation Center, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Tupelo, MS
National Provider Identifier
1205604071
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Practice address
1743 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone
(662) 550-8221
NPI assigned
Dec 12, 2023
Last updated
Dec 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
METHODIST OF MISSISSIPPI HOSPITAL & REHABILITATION CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Andrew Young
Title
Business Office Director
Phone
(601) 364-5340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1743 Cliff Gookin Blvd
Tupelo, MS 38801-6723

Mailing address

1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112
Phone (601) 364-5340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081117000461 MS Part A Provider - Hospital 8921912270 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flowood, MS; Tupelo, MS; Starkville, MS; Ridgeland, MS; Oxford, MS; Monroe, LA; Meridian, MS; Jackson, MS…
O20240603000466 MS DME Supplier - Medical Supply Company With Orthotic-Prosthetic 8921912270 Practice locations: Tupelo, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205604071. Details of each certification follow.

Hospital certification: CCN 250152

Legal name
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Doing business as
METHODIST REHAB CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 2002
Last certification
Apr 3, 2002
Beds
124
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1350 East Woodrow Wilson
Methodist Rehabilitation Center
Jackson, MS 39216-5112
Other Hospital Practice Location
Hospital subgroups
General, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mississippi Methodist Rehab CtrCCN 250152 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mississippi Methodist Hospital & Re1743 Cliff Gookin Blvd, Tupelo, MS 38801-6723(662) 550-8221 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 2026

National Provider Directory

National Provider Directory
Part of
Me Methodist Rehab Ctr

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gary Armstrong Individual Corporate OfficerExec VP Finance Jul 1, 2002
W-2 Managing EmployeeCfo Jul 1, 2002
Renee Morgan Individual W-2 Managing Employee Feb 9, 2023

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Methodist Rehab CenterJackson, MS, CCN 25T152 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1975

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 162

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 162

NPI Registry JSON

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

{
    "created_epoch": "1702339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1205604071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165112",
            "telephone_number": "601-364-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1743 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-550-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METHODIST OF MISSISSIPPI HOSPITAL & REHABILITATION CENTER",
        "enumeration_date": "2023-12-12",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "601-364-5340"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.