NPIMap

Organization Active NPI

Copiah County Medical Center

Doing business as Wesson Clinic

  • Rural Health Clinic/Center
  • Wesson, MS
National Provider Identifier
1720650237
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COPIAH COUNTY MEDICAL CENTER
Doing business as
Wesson Clinic
Practice address
1096 Beech St
Wesson, MS 39191
Phone
(601) 894-2514
Fax
(601) 643-6009
NPI assigned
Jul 14, 2021
Last updated
Jun 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COPIAH COUNTY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Kortney M. Gaddy
Title
Cfo
Phone
(601) 574-7200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1096 Beech St
Wesson, MS 39191

Mailing address

27190 Hwy 28
Hazlehurst, MS 39083
Phone (601) 574-7200

Other names 1

  • Wesson Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230405003100 MS Part A Provider - Rural Health Clinic 2062583487 Practice locations: Wesson, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720650237. Details of each certification follow.

Rural health clinic certification: CCN 258674

Legal name
COPIAH COUNTY MEDICAL CENTER
Doing business as
WESSON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 20, 2023
Last certification
Dec 20, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
May 1, 2022 in MS
Enrollment address
1096 Beech St
Wesson, MS 39191-6847
Related CCNs
251327

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

Other NPIs with the same Medicare PAC ID 3

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

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
25D2231206Wesson Clinic1096 Beech St Ste a, Wesson, MS 39191Certificate of waiverJul 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Copiah Medical Associates2 organizations share this tax ID, including this one
Part of
Kliesch Med Assoc PA

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Kortney Gaddy Individual Corporate OfficerCfo May 1, 2022
W-2 Managing EmployeeCfo May 1, 2022
Operational/Managerial ControlCfo May 1, 2022
Other May 1, 2022

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Copiah County Medical CenterHazlehurst, MS, CCN 251327 Hospital Operational/Managerial Control (100%) Jan 1, 2006
Copiah County Medical CenterHazlehurst, MS, CCN 25Z327 Hospital Operational/Managerial Control (100%) Jan 1, 2006
Crystal Springs ClinicCrystal Springs, MS, CCN 258675 Rural health clinic Other May 1, 2022

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1720650237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27190 HWY 28",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "39083",
            "telephone_number": "601-574-7200",
            "fax_number": "601-643-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 BEECH ST",
            "city": "WESSON",
            "state": "MS",
            "postal_code": "39191",
            "telephone_number": "601-894-2514",
            "fax_number": "601-643-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPIAH COUNTY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COPIAH COUNTY MEDICAL CENTER",
        "enumeration_date": "2021-07-14",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "GADDY",
        "authorized_official_first_name": "KORTNEY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-574-7200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wesson Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wesson, MS

Sources for this page

Verify at the official NPI Registry.