Health Facility Laboratory

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HEALTH FACILITY LABORATORY

Doing business as

Pmgroup
Pine Grove Behavioral Health

Practice address

300 Fairway Dr
Hattiesburg, MS 39401-7715

Phone

(601) 329-1321

NPI assigned

Feb 2, 2021

Last updated

May 6, 2024By 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

Jacob Parker, MDNPI 1326510751

Title

Registerd Nurse

Phone

(601) 329-1321

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 2

• PMGROUP Doing business as
• Pine Grove Behavioral Health Doing business as

Electronic endpoints 2

Tax ID family

Health Facility Laboratory5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Economic Stimulus Act Student Loan Refund 1200 Dollars

  • Pharmacy
  • Hattiesburg, MS
  • NPI 1255999835
  NPD tax ID
• Epic Systems Corporation Applied Informatics Physician

  • Private Vehicle
  • Honolulu, HI
  • NPI 1568095503
  NPD tax ID
• Health Facility Laboratory

  • Physiological Laboratory
  • Honolulu, HI
  • NPI 1124585336
  NPD tax ID
• Wellcare Medicare

  • Preferred Provider Organization
  • Saint Louis, MO
  • NPI 1649869678
  NPD tax ID

Locations

Practitioners 1

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.

• Jacob C. Parker, DO, MD

  • Other Specialist/Technologist
  • Hattiesburg, MS
  • NPI 1326510751
  Authorized official Same address or phone

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1699366542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FAIRWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017715",
            "telephone_number": "601-329-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FAIRWAY DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017715",
            "telephone_number": "601-329-1321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Forrest St",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394013455",
            "country_code": "US",
            "telephone_number": "601-545-6055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HEALTH FACILITY LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "REGISTERD NURSE",
        "authorized_official_telephone_number": "601-329-1321",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347D00000X",
            "taxonomy_group": "",
            "desc": "Train",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABORATORY",
            "identifier": "MS0800375",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE PROVIDER EMPLOYEE",
            "identifier": "MS0800375",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "1up.health",
            "affiliation": "N",
            "endpointDescription": "1up.health/patient",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "1up.health/patient",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "HTML",
            "address_1": "400 Forrest St",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394013455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.dropbox.com",
            "affiliation": "N",
            "endpointDescription": "Lane testing",
            "address_1": "300 Fairway Dr",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394017715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PMGROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pine Grove Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.