NPIMap

Organization Active NPI

South Central Clinics, Inc.

Doing business as South Central Diagnostic Center

  • General Practice Physician
  • Laurel, MS
National Provider Identifier
1619346863
Registry record updated Jan 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SOUTH CENTRAL CLINICS, INC.
Doing business as
South Central Diagnostic Center
Practice address
1440 Jefferson St
Suite B
Laurel, MS 39440-4243
Phone
(601) 649-6213
Fax
(601) 649-6217
NPI assigned
Sep 17, 2015
Last updated
Jan 19, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH CENTRAL REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 19, 2017

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

Authorized official

Name
James T Canizaro
Title
Cfo/VP of Finance
Phone
(601) 399-6139

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

1440 Jefferson St
Suite B
Laurel, MS 39440-4243

Mailing address

PO Box 247
Laurel, MS 39441-0247
Phone (601) 425-7550

Other identifiers 1

IdentifierTypeStateIssuer
01880574MedicaidMS

Other names 1

  • SOUTH CENTRAL DIAGNOSTIC CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140515000834 MS Part B Supplier - Clinic/Group Practice 4385876655 Receives reassigned benefits from 214 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sandersville, MS; Laurel, MS; Collins, MS; Ellisville, MS

Other NPIs on the same Medicare enrollment 26

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

View all 26

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0319147South Central Diagnostic Center1440 Jefferson Street, Suite B, Laurel, MS 39440ComplianceOct 13, 2027

National Provider Directory

National Provider Directory
Part of
South Central

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1619346863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-425-7550",
            "fax_number": "601-399-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 JEFFERSON ST",
            "address_2": "SUITE B",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404243",
            "telephone_number": "601-649-6213",
            "fax_number": "601-649-6217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL CLINICS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "enumeration_date": "2015-09-17",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "CANIZARO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO/VP OF FINANCE",
        "authorized_official_telephone_number": "601-399-6139"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01880574",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH CENTRAL DIAGNOSTIC CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.