Providence Hospice South, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

138 Issued in MS

Legal business name

PROVIDENCE HOSPICE SOUTH, LLC

Practice address

811 Rebecca Ave
Hattiesburg, MS 39401

Phone

(601) 705-0360

Fax

(601) 705-0365

NPI assigned

May 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michelle E Meeks, RN

Title

Administrator

Phone

(601) 705-0360

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1508814708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 REBECCA AVE",
            "address_2": "PROVIDENCE HOSPICE SOUTH",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39401",
            "telephone_number": "601-705-0360",
            "fax_number": "601-705-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 REBECCA AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39401",
            "telephone_number": "601-705-0360",
            "fax_number": "601-705-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOSPICE SOUTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "MEEKS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-705-0360",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08158561",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.