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Southwest Mississippi Regional Medical Center

Organization Active NPI Critical Access Hospital · Monticello, MS

NPI 1669576385 · NPPES record last updated Aug 13, 2020

Key facts

NPI
1669576385
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
11-222 (MS)
Legal business name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Practice address
1065 E Broad St
Monticello, MS 39654-7703
Phone
(601) 587-4051
Fax
(601) 587-0306
NPI assigned
Sep 12, 2006
Organization subpart
Yes
Parent organization (as reported)
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER

Authorized official

Name
Mrs. Charla Rowley
Title
Ceo
Phone
(601) 249-1806

Owned or controlled facilities with NPI records 5

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 32

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

View all 32

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

Facilities with the same owner 5

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

Practitioners 83

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 83

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

Hospital certification: CCN 25Z305

Legal name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Organization structure
Other · Non-profit
Enrollment address
1065E Broad St
Lawrence County Swing Bed Unit
Monticello, MS 39654-7703
Other Hospital Practice Location

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
City of McComb, Mississippi
Organization · McComb, MS 		5% Or Greater Direct Ownership Interest Oct 4, 1967 45%
Mallory Ginn
Individual 		Corporate Director
Dir of Revenue Cycle		 Nov 28, 2012
W-2 Managing Employee
Dir of Revenue Cycle		 Nov 28, 2012
Angela M Weems
Individual 		W-2 Managing Employee
Credentialing Officer		 Jun 1, 2012
Pike County Board of Supervisors
Organization · Magnolia, MS 		5% Or Greater Direct Ownership Interest Oct 4, 1967 45%
Amite County, Board of Supervisors
Organization · Liberty, MS 		5% Or Greater Direct Ownership Interest Oct 4, 1967 10%
Charla Rowley
Individual 		Corporate Officer
Ceo		 Apr 17, 2014

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
St. Luke Home Health and Hospice
McComb, MS · CCN 257124		 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2001
St. Luke Home Health and Hospice
Monticello, MS · CCN 251687		 Hospice 5% Or Greater Indirect Ownership Interest (100%) Feb 22, 2002
Southwest Primary Care
McComb, MS · CCN 258567		 Rural health clinic 5% Or Greater Direct Ownership Interest Feb 1, 2012
Womens Health Center
McComb, MS · CCN 258642		 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2019
Nov 1, 2019
Lawrence County Board of Supervisors
Monticello, MS · CCN 258692		 Rural health clinic Operational/Managerial Control Sep 27, 2001

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080512000321 MS Part a Provider - Critical Access Hospital 5193633907 Practice locations: Monticello, MS

National Provider Directory

Tax ID family
Smrmcgastroenterology (33 organizations share this tax ID)
Part of
Smrmcgastroenterology

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 11-222 MS Yes

Addresses

Primary practice location

1065 E Broad St
Monticello, MS 39654-7703

Mailing address

PO Box 788
Monticello, MS 39654-0788
Phone (601) 587-4051

Other identifiers

IdentifierTypeStateIssuer
00029404MedicaidMS

Other names

  • Lawrence County Hospital Swingbed Doing business as

Other providers in Monticello, MS

All providers in Monticello, MS · Critical Access Hospital in Mississippi

Sources for this page

Verify at the official NPI Registry.