Children'S International, LLC
Organization Active NPI Rural Health Clinic/Center · Gautier, MS
NPI 1720775265 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1720775265
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CHILDREN'S INTERNATIONAL, LLC
- Practice address
- 341 US 90
Ste a
Gautier, MS 39553 - Phone
- (228) 400-0098
- Fax
- (833) 518-1886
- NPI assigned
- Apr 24, 2023
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lindsey Zierhut
- Title
- Director of Medical Staff Affairs
- Phone
- (985) 646-1580
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 26
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Rural health clinic certification: CCN A53835
- Legal name
- CHILDREN'S INTERNATIONAL, LLC
- Doing business as
- CHILDREN'S INTERNATIONAL MEDICAL GROUP
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 1, 2023
- Last certification
- Nov 1, 2023
- Ownership / control type
- 1B
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 13, 1993 in LA
- Enrollment address
- 341 US-90
Suite a
Gautier, MS 39553
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Eduardo J Hernandez |
Corporate Officer |
Jan 20, 2010 | 50% |
| Corporate Director |
Jan 20, 2010 | 50% | |
| Lacey Shaw |
W-2 Managing Employee |
Jul 6, 2010 | |
| Brittany Frost |
W-2 Managing Employee |
Aug 1, 2009 | |
| The Living Trust of Eduardo and Heidi Hernandez |
5% Or Greater Direct Ownership Interest | Sep 5, 2013 | 100% |
| Heidi B Hernandez |
Corporate Officer |
Jan 20, 2010 | |
| Corporate Director |
Jan 20, 2010 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230623000077 | MS | Part a Provider - Rural Health Clinic | 1254633308 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gautier, MS |
National Provider Directory
- Tax ID family
- Children'S International LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
341 US 90
Ste a
Gautier, MS 39553
Mailing address
59101 Amber St
Slidell, LA 70461-3708
Phone (985) 646-1580
Other names
- Children's International Medical Group
Other providers in Gautier, MS
- Julia Regina Cate
- Colleen Elaine Chambers
- Marquesha Lachelle Chaney
- Bernice Chastang
- La'Tisha Shenay Chastang
- Brenda Childress
- Deveney M.K. Ching
- Sherry Laverne Chisholm
- Robin Rae Ciriello
- Rose Ellen Clifford
All providers in Gautier, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.