NPIMap

Organization Active NPI

Mississippi Band of Choctaw Indians

Doing business as Red Water Satellite Clinic

  • Federal Public Health Clinic/Center
  • Carthage, MS
National Provider Identifier
1275611543
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federal Public Health Clinic/CenterTaxonomy code 261QP0904X
Legal business name
MISSISSIPPI BAND OF CHOCTAW INDIANS
Doing business as
Red Water Satellite Clinic
Practice address
1930 N Pearl St
Carthage, MS 39051-8220
Phone
(601) 656-2211
Fax
(601) 663-7721
NPI assigned
Nov 2, 2006
Last updated
Jun 15, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSISSIPPI BAND OF CHOCTAW INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

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

Authorized official

Name
Mrs. Phyllis J Anderson
Title
Tribal Chief
Phone
(601) 656-2211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federal Public Health Clinic/Center 261QP0904X NU Primary

Addresses

Primary practice location

1930 N Pearl St
Carthage, MS 39051-8220

Mailing address

210 Hospital Cir
Choctaw, MS 39350-6781
Phone (601) 656-2211

Other names 1

  • RED WATER SATELLITE CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040126000871 TX Part B Supplier - Clinic/Group Practice 4385546662 Receives reassigned benefits from 71 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Choctaw, MS; Philadelphia, MS; Conehatta, MS; Carthage, MS

Other NPIs on the same Medicare enrollment 6

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

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0706201Red Water Clinic1930 N Pearl Street, Carthage, MS 39051Certificate of waiverOct 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Choctaw Health Center Pharmacy10 organizations share this tax ID, including this one
Part of
Choctaw Health Center Pharmacy

Other organizations with this tax ID 9

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

Locations

1930 N Pearl St
Carthage, MS 39051
Phone (601) 287-6639

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339718400000",
    "number": "1275611543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HOSPITAL CIR",
            "city": "CHOCTAW",
            "state": "MS",
            "postal_code": "393506781",
            "telephone_number": "601-656-2211",
            "fax_number": "601-663-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 N PEARL ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390518220",
            "telephone_number": "601-656-2211",
            "fax_number": "601-663-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI BAND OF CHOCTAW INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI BAND OF CHOCTAW INDIANS",
        "enumeration_date": "2006-11-02",
        "last_updated": "2012-06-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TRIBAL CHIEF",
        "authorized_official_telephone_number": "601-656-2211",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RED WATER SATELLITE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carthage, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.