NPIMap

Organization Active NPI

Outpatient Rehabilitation Center of Fulton Inc

  • Rehabilitation Clinic/Center
  • Fulton, MS
National Provider Identifier
1669538823
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
OUTPATIENT REHABILITATION CENTER OF FULTON INC
Practice address
406 Interchange Drive
Fulton, MS 38843-8900
Phone
(662) 862-3070
Fax
(662) 862-4970
NPI assigned
Dec 29, 2006
Last updated
Sep 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Authorized official

Name
Angie B Izard
Title
Office Manager
Phone
(662) 862-3070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

406 Interchange Drive
Fulton, MS 38843-8900

Mailing address

PO Box 188
Fulton, MS 38843-0188
Phone (662) 862-3070

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140131001518 MS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2860567948 Receives reassigned benefits from 5 practitioners
Practice locations: Fulton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669538823. Details of each certification follow.

  • CCN 256550 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 256550

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
OUTPATIENT REHABILITATION OF F
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jul 1, 1996
Last certification
Mar 26, 2021
Ownership / control type
Proprietary
Most recent change of ownership
Jan 1, 1999
Facility address
406 Interchange Drive
Fulton, MS 38843

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538006400000",
    "number": "1669538823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "FULTON",
            "state": "MS",
            "postal_code": "388430188",
            "telephone_number": "662-862-3070",
            "fax_number": "662-862-4970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 INTERCHANGE DRIVE",
            "city": "FULTON",
            "state": "MS",
            "postal_code": "388438900",
            "telephone_number": "662-862-3070",
            "fax_number": "662-862-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTPATIENT REHABILITATION CENTER OF FULTON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2018-09-27",
        "status": "A",
        "authorized_official_last_name": "IZARD",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-862-3070"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MS

Sources for this page

Verify at the official NPI Registry.