NPIMap

Organization Active NPI

South Central Clinics, Inc

Doing business as Laurel Pediatric and Adolescent Clinic

  • Rural Health Clinic/Center
  • Laurel, MS
National Provider Identifier
1316975394
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTH CENTRAL CLINICS, INC
Doing business as
Laurel Pediatric and Adolescent Clinic
South Central Pediatrics
Practice address
1002 Jefferson Street
Suite 200
Laurel, MS 39440
Phone
(601) 649-3520
Fax
(601) 649-7899
NPI assigned
Jun 29, 2006
Last updated
Dec 26, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH CENTRAL REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Authorized official

Name
Monica Morrow
Title
Director Clinic Support
Phone
(601) 399-6167

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Pediatric Adolescent Medicine Physician 2080A0000X NU

Addresses

Primary practice location

1002 Jefferson Street
Suite 200
Laurel, MS 39440

Mailing address

PO Box 247
Laurel, MS 39441-0247
Phone (601) 649-3520

Other identifiers 1

IdentifierTypeStateIssuer
08705378MedicaidMS

Other names 2

  • Laurel Pediatric and Adolescent Clinic Doing business as
  • South Central Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170208002047 MS Part A Provider - Rural Health Clinic 4385876655 Practice locations: Laurel, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316975394. Details of each certification follow.

Rural health clinic certification: CCN 258510

Legal name
SOUTH CENTRAL CLINICS, INC
Doing business as
SOUTH CENTRAL PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 23, 2003
Last certification
Dec 10, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Dec 14, 2012 in MS
Enrollment address
1002 Jefferson Street
Suite 200
Laurel, MS 39440-4306
Related CCNs
250058

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

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
25D0704312South Central Pediatrics1002 Jefferson Street, Suite 200, Laurel, MS 39440ComplianceMay 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
South Central Cinics Inc23 organizations share this tax ID, including this one
Part of
South Central Reg Med C

Other organizations with this tax ID 22

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

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elsa Brewer Individual Corporate OfficerBoard Member Dec 14, 2012
Victor Jones Individual Corporate OfficerBoard Member Dec 14, 2012
Lewis Goins Individual Corporate OfficerBoard Member Dec 14, 2012
Arthur Siggers Individual Corporate OfficerBoard Member Dec 14, 2012
Michael Lowe Individual Corporate OfficerBoard Member Dec 14, 2012
Monica Morrow Individual Corporate DirectorDirector of Clinic Support Serv Dec 14, 2012
W-2 Managing EmployeeDirector of Clinic Support Serv Dec 14, 2012
South Central Regional Medical Center Organization, Laurel, MS 5% Or Greater Direct Ownership Interest Dec 14, 2012 100%
James Canizaro Individual Corporate OfficerVP of Finance, Cfo Jul 1, 2002
George Douglas Higginbotham Individual Corporate OfficerPresident, Ceo Jun 22, 2004
George Walters Individual Corporate OfficerBoard Member Dec 14, 2012

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577318400000",
    "number": "1316975394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-649-3520",
            "fax_number": "601-649-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 JEFFERSON STREET",
            "address_2": "SUITE 200",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "39440",
            "telephone_number": "601-649-3520",
            "fax_number": "601-649-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL CLINICS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "enumeration_date": "2006-06-29",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A",
        "authorized_official_last_name": "MORROW",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "DIRECTOR CLINIC SUPPORT",
        "authorized_official_telephone_number": "601-399-6167"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08705378",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Pediatric and Adolescent Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Central Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Central Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.