NPIMap

Organization Active NPI

Aaron E Henry Community Health

  • Federally Qualified Health Center (FQHC)
  • Tunica, MS
National Provider Identifier
1609874700
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AARON E HENRY COMMUNITY HEALTH
Practice address
1820 Peabody St
Tunica, MS 38676-9441
Phone
(662) 363-3656
Fax
(662) 363-3789
NPI assigned
Jul 12, 2005
Last updated
Jun 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Ms. Aurelia Taylor
Title
Cheif Executive Office
Phone
(662) 624-4292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1820 Peabody St
Tunica, MS 38676-9441

Mailing address

510 Highway 322
P O Box 1216
Clarksdale, MS 38614-4717
Phone (662) 624-4292

Other identifiers 1

IdentifierTypeStateIssuer
09014578MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111109000379 MS Part A Provider - Federally Qualified Health Center (FQHC) 1153230560 Practice locations: Tunica, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609874700. Details of each certification follow.

Federally qualified health center certification: CCN 251838

Legal name
AARON E HENRY COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1979 in MS
Enrollment address
1820 Peabody St
Tunica, MS 38676-9441

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Aaron E Henry Community Health18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Michael Taylor Individual Corporate DirectorBoard Member Nov 8, 1994 100%
Lydia Rios Individual Corporate DirectorBoard Member May 19, 2010 100%
Larry Haynes Individual Corporate DirectorBoard Member Sep 21, 1989 100%
Aurelia Jones-Taylor Individual Corporate OfficerCeo Jun 5, 1989 100%
W-2 Managing EmployeeCeo Jun 5, 1989 100%
Josephine Rhymes Individual Corporate DirectorBoard Member Jan 12, 1994 100%
Robert Jackson Individual Corporate DirectorBoard Member May 11, 2004 100%

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1609874700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HIGHWAY 322",
            "address_2": "P O BOX 1216",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386144717",
            "telephone_number": "662-624-4292",
            "fax_number": "662-624-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 PEABODY ST",
            "city": "TUNICA",
            "state": "MS",
            "postal_code": "386769441",
            "telephone_number": "662-363-3656",
            "fax_number": "662-363-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AARON E HENRY COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "AURELIA",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICE",
        "authorized_official_telephone_number": "662-624-4292",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014578",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tunica, MS

Sources for this page

Verify at the official NPI Registry.