NPIMap

Individual provider Active NPI

Tiffany Edwards Keith, MHS, PA-C

  • Medical Physician Assistant
  • Laurel, MS
National Provider Identifier
1720441355
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA00374 Issued in MS
Practice address
1220 Jefferson St
Laurel, MS 39440-4355
Phone
(601) 426-4000
Fax
(601) 426-4105
NPI assigned
Mar 31, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA058228 PA
Medical Physician Assistant 363AM0700X PA00374 MS Primary

Addresses

Primary practice location

1220 Jefferson St
Laurel, MS 39440-4355

Mailing address

PO Box 247
Laurel, MS 39441-0247
Phone (601) 399-6169

Other practice location 1

700 High St
Williamsport Regional Medical Center, Attn: Joe Mileto
Williamsport, PA 17701-3100
Phone (570) 321-2142

Other names 1

  • Miss Tiffany Brooke Edwards Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180807002388 MS Practitioner - Physician Assistant 8224321799 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healogics Specialty Physicians of Mississippi LLCGroup PAC ID 5496052904, 10 clinicians

Practice addresses (Care Compare)

1220 Jefferson St
Laurel, MS 39440-4355
Phone (601) 426-4507

400 Hospital Rd
FL 3
Starkville, MS 39759-2163
Phone (662) 615-2791

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00374MSMDMedical Physician Assistant
MA058228PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Clinics, Inc CurrentSince Jun 29, 2018 Accepting new patients
South Central Clinics, Inc CurrentSince Jun 29, 2018 Accepting new patients
South Central Clinics, Inc. Past Accepting new patients
River Branch Emergency Physicians LLC Past Accepting new patients

Locations

1203 B Ave
Ellisville, MS 39437
Phone (601) 477-8553

1220 Jefferson St
Laurel, MS 39440
Phone (601) 426-4000

Interoperability endpoints

  • Direct secure messaging: tiffany.keith@direct.scrmc.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541376000000",
    "number": "1720441355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-399-6169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404355",
            "telephone_number": "601-426-4000",
            "fax_number": "601-426-4105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 High St",
            "address_2": "Williamsport Regional Medical Center, Attn: Joe Mileto",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "177013100",
            "country_code": "US",
            "telephone_number": "570-321-2142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEITH",
        "first_name": "TIFFANY",
        "middle_name": "EDWARDS",
        "name_prefix": "Mrs.",
        "credential": "MHS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2018-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA058228",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA00374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "EDWARDS",
            "middle_name": "BROOKE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.