Active NPI
Tyler Holmes Memorial Hospital Xray
- Specialist
- Winona, MS
National Provider Identifier
1407095060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- TYLER HOLMES MEMORIAL HOSPITAL XRAY
- Practice address
- 409 Tyler Holmes Dr
Winona, MS 38967-1521 - Phone
- (662) 283-4114
- Fax
- (662) 283-4640
- NPI assigned
- Feb 5, 2009
- Organization subpart
- Yes
- Parent organization
- TYLER HOLMES MEMORIAL HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. R M Tyler
- Title
- Administrator
- Phone
- (662) 283-6127
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
409 Tyler Holmes Dr
Winona, MS 38967-1521
Mailing address
409 Tyler Holmes Dr
Winona, MS 38967-1521
Phone (662) 283-4114
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09012469 | Medicaid | MS | |
| 000019156 | Other | MS | BLUE CROSS |
| C00073 | Other | MS | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040126000826 | MS | Part B Supplier - Clinic/Group Practice | 0345142618 |
Receives reassigned benefits from 14 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Winona, MS; North Carrollton, MS; Kilmichael, MS |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Nurse Practitioner
- Kilmichael, MS
- NPI 1346084985
O20040126000826
-
- Rural Health Clinic/Center
- North Carrollton, MS
- NPI 1548883481
O20040126000826
National Provider Directory
National Provider Directory- Part of
- Tyler Holmes Memorial Hospital
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Critical Access Hospital
- Winona, MS
- NPI 1205868627
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233792000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1233792000000",
"number": "1407095060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 TYLER HOLMES DR",
"city": "WINONA",
"state": "MS",
"postal_code": "389671521",
"telephone_number": "662-283-4114",
"fax_number": "662-283-4640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 TYLER HOLMES DR",
"city": "WINONA",
"state": "MS",
"postal_code": "389671521",
"telephone_number": "662-283-4114",
"fax_number": "662-283-4640"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TYLER HOLMES MEMORIAL HOSPITAL XRAY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TYLER HOLMES MEMORIAL HOSPITAL",
"enumeration_date": "2009-02-05",
"last_updated": "2009-02-05",
"status": "A",
"authorized_official_last_name": "TYLER",
"authorized_official_first_name": "R",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "662-283-6127",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09012469",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "000019156",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "C00073",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winona, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.