NPIMap

Organization Active NPI

Kilmichael Hospital

Doing business as Kilmichael Hospital Professional Group

  • Diagnostic Radiology Physician
  • Kilmichael, MS
National Provider Identifier
1518176445
Registry record updated May 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MS06391 Issued in MS
Legal business name
KILMICHAEL HOSPITAL
Doing business as
Kilmichael Hospital Professional Group
Practice address
301 Lamar Ave.
Kilmichael, MS 39747-0188
Phone
(662) 262-4311
Fax
(662) 262-5586
NPI assigned
May 21, 2007
Last updated
May 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2011

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

Authorized official

Name
Mr. Calvin Dexter Johnson II
Title
Administrator
Phone
(662) 262-4311

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R605859 MS
Primary Care Nurse Practitioner 363LP2300X R504696 MS
Family Medicine Physician 207Q00000X 12496 MS
Family Medicine Physician 207Q00000X 16482 MS
Cardiovascular Disease Physician 207RC0000X 000010138 MS
Cardiovascular Disease Physician 207RC0000X 10138 MS
Diagnostic Radiology Physician 2085R0202X MS06391 MS Primary

Addresses

Primary practice location

301 Lamar Ave.
Kilmichael, MS 39747-0188

Mailing address

PO Box 188
Kilmichael, MS 39747-0188
Phone (662) 262-4311

Other identifiers 2

IdentifierTypeStateIssuer
03335377MedicaidMS
19147OtherMSPROFESSIONAL COMPONENT

Other names 1

  • Kilmichael Hospital Professional Group Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1518176445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "KILMICHAEL",
            "state": "MS",
            "postal_code": "397470188",
            "telephone_number": "662-262-4311",
            "fax_number": "662-262-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 LAMAR AVE.",
            "city": "KILMICHAEL",
            "state": "MS",
            "postal_code": "397470188",
            "telephone_number": "662-262-4311",
            "fax_number": "662-262-5586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILMICHAEL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CALVIN",
        "authorized_official_middle_name": "DEXTER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-262-4311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R605859",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "R504696",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "12496",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "16482",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "000010138",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "10138",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "MS06391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03335377",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL COMPONENT",
            "identifier": "19147",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kilmichael Hospital Professional Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kilmichael, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.