NPIMap

Organization Active NPI

Ms State Veterans Home Kosciusko

  • Skilled Nursing Facility
  • Kosciusko, MS
National Provider Identifier
1295220598
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
806 Issued in MS
Legal business name
MS STATE VETERANS HOME KOSCIUSKO
Practice address
310 Autumn Ridge Dr
Kosciusko, MS 39090-3242
Phone
(662) 290-3000
Fax
(662) 289-7824
NPI assigned
Jun 28, 2018
Organization subpart
Yes
Parent organization
MS STATE VETERANS AFFAIRS BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Authorized official

Name
David Poche
Title
Pharmacist
Phone
(662) 290-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 806 MS Primary
Institutional Pharmacy 3336I0012X

Addresses

Primary practice location

310 Autumn Ridge Dr
Kosciusko, MS 39090-3242

Mailing address

310 Autumn Ridge Dr
Kosciusko, MS 39090-3242
Phone (662) 290-3000

National Provider Directory

National Provider Directory
Tax ID family
State Veterans Affairs4 organizations share this tax ID, including this one
Part of
State Veterans Affairs

Other organizations with this tax ID 3

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

Locations

310 Autumn Ridge Dr
Kosciusko, MS 39090
Phone (662) 289-3499

NPI Registry JSON

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1295220598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 AUTUMN RIDGE DR",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903242",
            "telephone_number": "662-290-3000",
            "fax_number": "662-289-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 AUTUMN RIDGE DR",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903242",
            "telephone_number": "662-290-3000",
            "fax_number": "662-289-7824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MS STATE VETERANS HOME KOSCIUSKO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MS STATE VETERANS AFFAIRS BOARD",
        "enumeration_date": "2018-06-28",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "POCHE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "662-290-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "806",
            "primary": true
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.