Mid South Rehab Outpatient Clinic LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MID SOUTH REHAB OUTPATIENT CLINIC LLC

Practice address

3131 N Highland Ave
Jackson, TN 38305-3418

Phone

(601) 605-6777

Fax

(601) 607-1415

NPI assigned

Jan 5, 2017

Organization subpart

No

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

Authorized official

Name

Charlean Ransom Williams, OTR/L, CHC

Title

VP of Compliance/Him

Phone

(601) 909-4210

Specialties & licenses 1

Addresses

Other names 1

• 360 Total Rehab Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Mid South Rehab Outpatient Clinic LLC

  • Physical Therapy Clinic/Center
  • Ridgeland, MS
  • NPI 1417280009

  2961543004

  Same PAC ID

Tax ID family

360 Total Rehab3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Mid South Rehab Outpatient Clinic LLC

  • Physical Therapy Clinic/Center
  • Ridgeland, MS
  • NPI 1417280009
  NPD tax ID
• Mid South Rehab Outpatient, LLC

  • Rehabilitation Clinic/Center
  • Huntsville, AL
  • NPI 1447580915
  NPD tax ID

Locations

Practitioners 6

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

• Nichole Grice Lamberth, MPT

  • Orthopedic Physical Therapist
  • Erin, TN
  • NPI 1194182246
  NPD (past)
• Tamara Mays, OT

  • Occupational Therapist
  • Erin, TN
  • NPI 1164386884
  NPD (past)
• Shannon Rouse

  • Physical Therapist
  • Erin, TN
  • NPI 1124485420
  NPD (past)
• Ashleigh Walters, PT

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Erin, TN
  • NPI 1164291258
  NPD (past)
• Leigh Robertson, PT

  • Physical Therapist
  • Flowood, MS
  • NPI 1295802833
  NPD (past)
• Scott Towne, PTA

  • Physical Therapy Assistant
  • Flowood, MS
  • NPI 1598984064
  NPD (past)

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1265977847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599C STEED RD",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391571707",
            "telephone_number": "601-605-6777",
            "fax_number": "601-607-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 N HIGHLAND AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053418",
            "telephone_number": "601-605-6777",
            "fax_number": "601-607-1415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3507 W Main St",
            "address_purpose": "LOCATION",
            "city": "Erin",
            "state": "TN",
            "postal_code": "370614148",
            "country_code": "US",
            "telephone_number": "931-289-5460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MID SOUTH REHAB OUTPATIENT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CHARLEAN",
        "authorized_official_middle_name": "RANSOM",
        "authorized_official_title_or_position": "VP OF COMPLIANCE/HIM",
        "authorized_official_telephone_number": "601-909-4210",
        "authorized_official_credential": "OTR/L, CHC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "360 Total Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keith A Micetich, MD
• Michael E Steuer MD PC
• Michael W King, DDS, PLC
• Cameron Michael, DO
• Mid - South Heart Center PC
• Mid South Retina Associates, LLC
• Mid-South Enhanced Cardiac Care PLLC
• Mid-South Hearing, LLC
• Mid-South Lung Center PLC
• Mid-South Perinatal Associates PC

• Physical Therapy Clinic/Center in Jackson, TN
• Providers in Jackson, TN by specialty
• Physical Therapy Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.