NPIMap

Organization Active NPI

South Sunflower County Hospital

Doing business as Delta Surgical Clinic

  • Clinic/Center
  • Indianola, MS
National Provider Identifier
1487685897
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
11-102 Issued in MS
Legal business name
SOUTH SUNFLOWER COUNTY HOSPITAL
Doing business as
Delta Surgical Clinic
Practice address
110 E Baker St
Indianola, MS 38751-2451
Phone
(662) 887-7339
Fax
(662) 887-3920
NPI assigned
Jul 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Harold J. Blessitt
Title
Hospital Administrator
Phone
(662) 887-5235

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 11-102 MS Primary

Addresses

Primary practice location

110 E Baker St
Indianola, MS 38751-2451

Mailing address

110 E Baker St
Indianola, MS 38751-2451
Phone (662) 887-7339

Other identifiers 1

IdentifierTypeStateIssuer
09014437MedicaidMS

Other names 1

  • Delta Surgical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000979 MS Part B Supplier - Clinic/Group Practice 6709771637 Receives reassigned benefits from 88 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indianola, MS

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
South Sunflower County14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 72

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 72

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487685897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E BAKER ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512451",
            "telephone_number": "662-887-7339",
            "fax_number": "662-887-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E BAKER ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512451",
            "telephone_number": "662-887-7339",
            "fax_number": "662-887-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SUNFLOWER COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLESSITT",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "662-887-5235",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "11-102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014437",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianola, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.