NPIMap

Organization Active NPI

Central Mississippi Civic Improvement Association

Doing business as Jackson Hinds Comprehensive Health Center

  • Federally Qualified Health Center (FQHC)
  • Vicksburg, MS
National Provider Identifier
1265464556
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION
Doing business as
Jackson Hinds Comprehensive Health Center
Practice address
3312 Oak St
Vicksburg, MS 39180-5042
Phone
(601) 629-9500
Fax
(601) 638-9044
NPI assigned
Jul 7, 2006
Last updated
Sep 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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

Authorized official

Name
Dr. Jasmin Champman, DDS
Title
Ceo
Phone
(601) 362-5321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3312 Oak St
Vicksburg, MS 39180-5042

Mailing address

3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321

Other identifiers 1

IdentifierTypeStateIssuer
09014146MedicaidMS

Other names 1

  • Jackson Hinds Comprehensive Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265464556. Details of each certification follow.

  • CCN 251897 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 251897

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
JACKSON HINDS COMP HC TRI-CTY HLTH GRP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 21, 2002
Last certification
Jun 21, 2002
Ownership / control type
For profit – corporation
Facility address
3312 Oak Street
Vicksburg, MS 39180

National Provider Directory

National Provider Directory
Tax ID family
Central Mississippi Civic Imrovement Association46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1265464556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-362-5321",
            "fax_number": "601-364-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 OAK ST",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805042",
            "telephone_number": "601-629-9500",
            "fax_number": "601-638-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "CHAMPMAN",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-362-5321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014146",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Hinds Comprehensive Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.