Starkville Manor Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

555 Issued in MS

Legal business name

STARKVILLE MANOR HEALTHCARE LLC

Practice address

1001 Hospital Road
Starkville, MS 39760-1466

Phone

(662) 323-6360

Fax

(662) 323-4413

NPI assigned

Jun 14, 2006

Organization subpart

No

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

Authorized official

Name

Tim Lehner

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Starkville Manor Health Care and Rehabilitation Center Doing business as

Electronic endpoints 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adelaide Frances Henderson, MD

  • Family Medicine Physician
  • Flowood, MS
  • NPI 1841289279
  NPD (past)
• Everett C McKibben, MD

  • General Practice Physician
  • Starkville, MS
  • NPI 1093873713
  NPD (past)
• Mitchell Craig Moffett, D.O.

  • Family Medicine Physician
  • Maben, MS
  • NPI 1881115707
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1215970397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1466",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397601466",
            "telephone_number": "662-323-6360",
            "fax_number": "662-323-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 HOSPITAL ROAD",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397601466",
            "telephone_number": "662-323-6360",
            "fax_number": "662-323-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARKVILLE MANOR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "LEHNER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000220164",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Starkville Manor Health Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Starkville Manor Health Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Starkville, MS
• Providers in Starkville, MS by specialty
• Skilled Nursing Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.