NPIMap

Organization Active NPI

Claiborne County Nursing Center Inc

  • Skilled Nursing Facility
  • Port Gibson, MS
National Provider Identifier
1225012941
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
679 Issued in MS
Legal business name
CLAIBORNE COUNTY NURSING CENTER INC
Practice address
2124 Old Highway 61 S
Port Gibson, MS 39150-2589
Phone
(601) 437-8737
Fax
(601) 437-8724
NPI assigned
Dec 6, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Tina L Ellis
Title
Comptroller
Phone
(601) 304-0980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 679 MS Primary

Addresses

Primary practice location

2124 Old Highway 61 S
Port Gibson, MS 39150-2589

Mailing address

PO Box 1018
2124 Old Hwy 61 South
Port Gibson, MS 39150-1018
Phone (601) 437-8737

Other identifiers 1

IdentifierTypeStateIssuer
00023182MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225012941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1018",
            "address_2": "2124 OLD HWY 61 SOUTH",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391501018",
            "telephone_number": "601-437-8737",
            "fax_number": "601-437-8724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 OLD HIGHWAY 61 S",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391502589",
            "telephone_number": "601-437-8737",
            "fax_number": "601-437-8724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAIBORNE COUNTY NURSING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "601-304-0980",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00023182",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Gibson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.