Covington County Hospital
Organization Active NPI Rural Health Clinic/Center · Taylorsville, MS
NPI 1306460282 · NPPES record last updated Jun 13, 2023
Key facts
- NPI
- 1306460282
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- COVINGTON COUNTY HOSPITAL
- Practice address
- 105 Eaton St
Taylorsville, MS 39168-5614 - Phone
- (601) 765-6711
- Fax
- (601) 698-0112
- NPI assigned
- Jun 5, 2020
- Organization subpart
- No
Authorized official
- Name
- Anissa L Evans
- Title
- Credentialing Director
- Phone
- (601) 698-0328
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 15
Practitioners 47
-
Nadia Shanise Clark, FNP-C
-
Shelby Slade Dickerson, FNP-C
-
David Shane Johnson, PA-C
-
Crystal Parker McNabb, FNP-C
-
Katie Daley Rush, CFNP
-
Anna Seals, FNP-C
-
Vanessa Storozuk, APRN, FNP-C
-
Mary Sue Watkins, CFNP
-
Terrie S Wilson, FNP-C
-
Kimberly Shere Bennett, LCSW
-
Lacey Blakeney, NP-C
-
Andrea Maureen Bruce, D.O.
-
Terri Lynn Byrd, FNP-C
-
Jason Evan Carr, NP
-
Andrew Daughton Chambers, FNP-BC
-
Laura Jean Davis, NP
-
Leigh P Drace, CFNP
-
Anna Fails, FNP
-
George Gillespie III, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2185754 | CCH Clinic Taylorsville | Certificate of waiver | Jun 8, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Covington County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Jan 1, 2016 |
| Arrington Living Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 1, 2011 May 1, 2011 |
| Family Medical Associates |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2016 |
| Family Care Express |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2016 Jan 1, 2016 |
| CCH Clinic Magee |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 1, 2018 Mar 1, 2018 |
| Express Care Sumrall |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2020 |
| Family Care of Magee |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 4, 2021 Jan 4, 2021 |
| Family Care Magee Tuscan Towers |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 1, 2021 Sep 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201103000549 | MS | Part B Supplier - Clinic/Group Practice | 4183517253 |
Receives reassigned benefits from 13 practitioners Practice locations: Taylorsville, MS |
National Provider Directory
Locations
105 Eaton St
Taylorsville, MS 39168
Phone (601) 452-4280
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
105 Eaton St
Taylorsville, MS 39168-5614
Mailing address
105 Eaton St
Taylorsville, MS 39168-5614
Phone (601) 765-6711
Other names
- CCH Clinic Taylorsville
Other providers in Taylorsville, MS
- Patricia Bullock
- Tenesha Coats
- Nicholas James Cvach
- Dental Professionals of Mississippi, P.C.
- Divine Behavioral Solutions
- Divine Behavioral Solutions
- Lawanda Nicole Ellis
All providers in Taylorsville, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.