NPIMap

Organization Active NPI

Physician Group

  • Multi-Specialty Clinic/Center
  • Meridian, MS
National Provider Identifier
1558679902
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
36-136 Issued in MS
Legal business name
PHYSICIAN GROUP
Practice address
4555 Highland Park Dr
Meridian, MS 39307-5429
Phone
(601) 581-7969
Fax
(601) 581-7676
NPI assigned
Sep 20, 2010
Last updated
May 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST MISSISSIPPI STATE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Dr. Charles Carlisle
Title
Hospital Director
Phone
(601) 581-7877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 36-136 MS Primary

Addresses

Primary practice location

4555 Highland Park Dr
Meridian, MS 39307-5429

Mailing address

PO Box 4128
Meridian, MS 39304-4128
Phone (601) 581-7969

National Provider Directory

National Provider Directory
Part of
East Mississippi State

Locations

1818 College Dr
Meridian, MS 39307
Phone (601) 581-7600

Practitioners & affiliated clinicians

Practitioners 3

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": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1558679902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4128",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393044128",
            "telephone_number": "601-581-7969",
            "fax_number": "601-581-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 HIGHLAND PARK DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393075429",
            "telephone_number": "601-581-7969",
            "fax_number": "601-581-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "enumeration_date": "2010-09-20",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "HOSPITAL DIRECTOR",
        "authorized_official_telephone_number": "601-581-7877",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MS",
            "license": "36-136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.