South Mississippi Regional

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

01345041 Issued in MS

Legal business name

SOUTH MISSISSIPPI REGIONAL

Practice address

1170 W Railroad St
Long Beach, MS 39560-4106

Phone

(228) 867-1331

Fax

(228) 867-1459

NPI assigned

Jul 25, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lionel Heidingsfelder, RPH

Title

Pharmacist

Phone

(228) 867-1331

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629091616. Details of each certification follow.

• CCN 25G008 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 25G008

Legal name

SOUTH MISSISSIPPI REGIONAL CEN

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jun 26, 1978

Last certification

Aug 14, 2025

Beds

130

Ownership / control type

State

Facility address

1170 W Railroad St
Long Beach, MS 39560

Tax ID family

South Mississippi Regional Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• South Mississippi Regional Center

  • Intellectual Disabilities Intermediate Care Facility
  • Long Beach, MS
  • NPI 1033143284
  NPD tax ID
• South Mississippi Regional Center

  • Intellectual Disabilities Intermediate Care Facility
  • Long Beach, MS
  • NPI 1578885117
  NPD tax ID
• South Mississippi Regional Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Long Beach, MS
  • NPI 1629392774
  NPD tax ID

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629091616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 W RAILROAD ST",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395604106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 W RAILROAD ST",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395604106",
            "telephone_number": "228-867-1331",
            "fax_number": "228-867-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MISSISSIPPI REGIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEIDINGSFELDER",
        "authorized_official_first_name": "LIONEL",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "228-867-1331",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MS",
            "license": "01345041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2518287",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00095206",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Simon-Fields Counseling & Consultation
• Carli Simpson, PLPC
• Rosalyn Roxan Sims
• Morietta Smith
• Norman Allen Smith, R.PH.
• South Mississippi Regional Center
• South Mississippi Regional Center
• South Mississippi Regional Center
• Southern Living Assistance Services
• John Stage

• Long Term Care Pharmacy in Long Beach, MS
• Providers in Long Beach, MS by specialty
• Long Term Care Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.