NPIMap

Organization Active NPI

MDB Behavioral Health Services LLC

  • Rural Health Clinic/Center
  • Vicksburg, MS
National Provider Identifier
1669835310
Registry record updated Feb 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MDB BEHAVIORAL HEALTH SERVICES LLC
Practice address
1911 Mission 66 Ste B
Vicksburg, MS 39180-3762
Phone
(601) 665-4162
Fax
(855) 830-3484
NPI assigned
Mar 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2026

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

Authorized official

Name
Christopher J Watkins, NP
Title
Member
Phone
(601) 951-9863

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X MS
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1911 Mission 66 Ste B
Vicksburg, MS 39180-3762

Mailing address

215 Katherine Dr Ste a
Flowood, MS 39232-9588
Phone (601) 665-4162

Other identifiers 2

IdentifierTypeStateIssuer
007877558MedicaidMS
001583061MedicaidMS

Other names 1

  • Complete Care Rural Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160708000104 MS Part B Supplier - Clinic/Group Practice 0749572915 Receives reassigned benefits from 178 practitioners
Practice locations: Vicksburg, MS
O20190621002752 MS Part A Provider - Rural Health Clinic 0749572915 Practice locations: Vicksburg, MS

Rural health clinic certification: CCN 253808

Legal name
MDB BEHAVIORAL HEALTH SERVICES LLC
Doing business as
COMPLETE CARE RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 28, 2009
Last certification
Jan 26, 2023
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Nov 19, 2013 in MS
Enrollment address
1911 Mission 66
Ste B
Vicksburg, MS 39180-3762

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
25D1068392Complete Care Rural Health Clinic1911 Mission 66 Ste B, Vicksburg, MS 39180Certificate of waiverMay 8, 2027

National Provider Directory

National Provider Directory

Locations

215 Katherine Dr
Flowood, MS 39232

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Gary a Roberson Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2019 49.5%
John C Duke Individual Corporate OfficerCoo Jun 15, 2016 1%
W-2 Managing Employee Aug 7, 2023
MDB Intermediate Inc Organization, Brandon, MS Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 28, 2026 100%
MDB Health Services LLC Organization, Flowood, MS LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 7, 2023 100%
Christopher John Watkins Individual 5% Or Greater Indirect Ownership InterestCeo Apr 1, 2019 49.5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 255

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

View all 255

NPI Registry JSON

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770854400000",
    "number": "1669835310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 KATHERINE DR STE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329588",
            "telephone_number": "601-665-4162",
            "fax_number": "855-830-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 MISSION 66 STE B",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803762",
            "telephone_number": "601-665-4162",
            "fax_number": "855-830-3484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDB BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-31",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-951-9863",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007877558",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001583061",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Care Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.