NPIMap

Organization Active NPI

Mizell Memorial Hospital, Inc.

  • Hospitalist Physician
  • Opp, AL
National Provider Identifier
1477032795
Registry record updated Dec 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
MIZELL MEMORIAL HOSPITAL, INC.
Practice address
702 N Main St
Opp, AL 36467-1626
Phone
(334) 493-3541
Fax
(334) 493-9664
NPI assigned
Aug 8, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2019

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

Authorized official

Name
Jana Wyatt
Title
Ceo / Cfo
Phone
(334) 493-9111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

702 N Main St
Opp, AL 36467-1626

Mailing address

PO Box 1010
Opp, AL 36467-1010
Phone (334) 493-3541

Other names 1

  • Mizell Memorial Hospitalist Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051220000136 AL Part B Supplier - Clinic/Group Practice 6507820990 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Opp, AL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Mizell Memorial Hospita5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577145600000",
    "number": "1477032795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1010",
            "city": "OPP",
            "state": "AL",
            "postal_code": "364671010",
            "telephone_number": "334-493-3541",
            "fax_number": "334-493-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N MAIN ST",
            "city": "OPP",
            "state": "AL",
            "postal_code": "364671626",
            "telephone_number": "334-493-3541",
            "fax_number": "334-493-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIZELL MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-08",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "CEO / CFO",
        "authorized_official_telephone_number": "334-493-9111"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mizell Memorial Hospitalist Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mizell Memorial Hospitalist Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Opp, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2019; 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.

Verify at the official NPI Registry.