NPIMap

Organization Active NPI

Tallahatchie General Hospital

  • Rural Health Clinic/Center
  • Tutwiler, MS
National Provider Identifier
1609322205
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TALLAHATCHIE GENERAL HOSPITAL
Practice address
17390 US Highway 49
Tutwiler, MS 38963-5143
Phone
(662) 345-8334
NPI assigned
Sep 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Authorized official

Name
Barbara Dover Crocker
Title
Him Director
Phone
(662) 625-7176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

17390 US Highway 49
Tutwiler, MS 38963-5143

Mailing address

PO Box 230
Charleston, MS 38921-0240
Phone (662) 345-8334

Other names 1

  • TUTWILER CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040303000646 MS Part B Supplier - Clinic/Group Practice 1052208097 Receives reassigned benefits from 25 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charleston, MS; Grenada, MS; Tutwiler, MS
O20161227000218 MS Part A Provider - Rural Health Clinic 1052208097 Practice locations: Tutwiler, MS

Rural health clinic certification: CCN 258620

Legal name
TALLAHATCHIE GENERAL HOSPITAL
Doing business as
TUTWILER CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 18, 2017
Last certification
Mar 27, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Incorporated
Dec 1, 2016 in MS
Enrollment address
17390 US Highway 49
Tutwiler, MS 38963-5143
Related CCNs
251304

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Tallahatchie Gen Hosp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tallahatchie General Hospital Organization, Charleston, MS Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2016 100%
Heather Godsey Individual W-2 Managing EmployeeRevenue Cycle Director Mar 8, 2024
Donald Blackwood Individual Corporate DirectorCeo Nov 1, 2016 100%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tallahatchie General HospitalCharleston, MS, CCN 251304 Hospital 5% Or Greater Direct Ownership Interest Feb 1, 2002
Holcomb ClinicGrenada, MS, CCN 258601 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774310400000",
    "number": "1609322205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "CHARLESTON",
            "state": "MS",
            "postal_code": "389210240",
            "telephone_number": "662-345-8334",
            "fax_number": "662-345-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17390 US HIGHWAY 49",
            "city": "TUTWILER",
            "state": "MS",
            "postal_code": "389635143",
            "telephone_number": "662-345-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHATCHIE GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "DOVER",
        "authorized_official_title_or_position": "HIM DIRECTOR",
        "authorized_official_telephone_number": "662-625-7176"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TUTWILER CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TUTWILER CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tutwiler, MS

Sources for this page

Verify at the official NPI Registry.