NPIMap

Organization Active NPI

Northeast Mississippi Health Care, Inc

Doing business as DeSoto Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Southaven, MS
National Provider Identifier
1447665385
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST MISSISSIPPI HEALTH CARE, INC
Doing business as
DeSoto Community Health Center
Practice address
7535 Airways Blvd
Southaven, MS 38671-5834
Phone
(662) 349-6220
NPI assigned
Jun 30, 2014
Last updated
Jun 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

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

Authorized official

Name
Marjorie McKinney
Title
Executive Director
Phone
(662) 838-2163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

7535 Airways Blvd
Southaven, MS 38671-5834

Mailing address

PO Box 698
Byhalia, MS 38611-0698

Other names 1

  • DeSoto Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040602001469 MS Part B Supplier - Clinic/Group Practice 5294717377 Receives reassigned benefits from 13 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Byhalia, MS; Mt Pleasant, MS; Southaven, MS
O20140723000068 MS Part A Provider - Federally Qualified Health Center (FQHC) 5294717377 Practice locations: Southaven, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447665385. Details of each certification follow.

Federally qualified health center certification: CCN 251024

Legal name
NORTHEAST MISSISSIPPI HEALTH CARE INC
Doing business as
DESOTO COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 22, 2014
Last certification
Jul 22, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 1979 in MS
Enrollment address
7535 Airways Blvd
Desoto Community Health Center
Southaven, MS 38671-5816

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
25D2076139Desoto Community Health Center7535 Airways Blvd Ste 101, Southaven, MS 38671Certificate of waiverApr 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
NE Ms HLTH Care Flu Dem4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Annabelle Cabe Individual W-2 Managing Employee Jan 1, 2015
Clifton Rodgers Individual 5% Or Greater Indirect Ownership InterestExecutive Director Oct 1, 2011 100%
Corporate OfficerChair,Board of Directors Jan 1, 2014
Corporate DirectorExecutive Director Oct 1, 2011 100%
OtherExecutive Director Jul 7, 2014

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1447665385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 698",
            "city": "BYHALIA",
            "state": "MS",
            "postal_code": "386110698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7535 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715834",
            "telephone_number": "662-349-6220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MISSISSIPPI HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY",
        "authorized_official_first_name": "MARJORIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-838-2163"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeSoto Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.