NPIMap

Organization Active NPI

East Mississippi State Hospital

Doing business as Magnolia Medical Clinic

  • Multi-Specialty Clinic/Center
  • Meridian, MS
National Provider Identifier
1346522653
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
31-136 Issued in MS
Legal business name
EAST MISSISSIPPI STATE HOSPITAL
Doing business as
Magnolia Medical Clinic
Practice address
1818 College Drive
Meridian, MS 39307-5429
Phone
(601) 581-7562
Fax
(601) 581-7676
NPI assigned
Sep 13, 2011
Last updated
May 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST MISSISSIPPI STATE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Charles Carlisle
Title
Hospital Director
Phone
(601) 581-7878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 31-136 MS Primary

Addresses

Primary practice location

1818 College Drive
Meridian, MS 39307-5429

Mailing address

1818 College Drive
Meridian, MS 39307-5429
Phone (601) 581-7562

Other names 1

  • Magnolia Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Part of
East Mississippi St Hos

Locations

1451 N Lakeland Dr
#P
Meridian, MS 39307
Phone (601) 581-7969

1818 College Dr
Meridian, MS 39307
Phone (601) 581-7600

5701 N Hills St
Meridian, MS 39307
Phone (601) 581-7562

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1346522653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 COLLEGE DRIVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393075429",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 COLLEGE DRIVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393075429",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "enumeration_date": "2011-09-13",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "HOSPITAL DIRECTOR",
        "authorized_official_telephone_number": "601-581-7878"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MS",
            "license": "31-136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magnolia Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.