NPIMap

Organization Active NPI

Tyler Holmes Memorial Hospital

  • Rural Health Clinic/Center
  • Winona, MS
National Provider Identifier
1730367459
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TYLER HOLMES MEMORIAL HOSPITAL
Practice address
702 Woodland Dr
Winona, MS 38967-1530
Phone
(662) 283-8205
Fax
(662) 283-6747
NPI assigned
Feb 5, 2008
Organization subpart
Yes
Parent organization
TYLER HOLMES MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Authorized official

Name
Cori H Bailey
Title
Ceo
Phone
(662) 283-6126

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

702 Woodland Dr
Winona, MS 38967-1530

Mailing address

702 Woodland Dr
Winona, MS 38967-1530
Phone (662) 283-8205

Other identifiers 12

IdentifierTypeStateIssuer
008203508MedicaidMS
2070889OtherMSWELLCARE
8009711MedicaidMS
005330334MedicaidMS
007870552MedicaidMS
1497164446OtherMSNPI
1730367459OtherMSNPI
1730550419OtherMSNPI
200007660MedicaidMS
2163489OtherMSWELLCARE
08203508MedicaidMS
1659550127OtherMSNPI

Other names 1

  • Crossroads Family Medicine Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040126000826 MS Part B Supplier - Clinic/Group Practice 0345142618 Receives reassigned benefits from 14 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winona, MS; North Carrollton, MS; Kilmichael, MS
O20190222000070 MS Part A Provider - Rural Health Clinic 0345142618 Practice locations: Winona, MS

Rural health clinic certification: CCN 258640

Legal name
TYLER HOLMES MEMORIAL HOSPITAL
Doing business as
CROSSROADS FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 19, 2020
Last certification
May 19, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
702 Woodland Drive
Winona, MS 38967-1530
Related CCNs
251312

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).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
25D1081237Crossroads Family Medicine702 Woodland Drive, Winona, MS 38967Certificate of waiverMar 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Tyler Holmes Memorial Hospital7 organizations share this tax ID, including this one
Part of
Tyler Holmes Memorial Hospital

Other organizations with this tax ID 6

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

Locations

400 Lamar Ave
Kilmichael, MS 39747
Phone (662) 262-1060

702 Woodland Dr
Winona, MS 38967
Phone (662) 283-8205

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Tyler Holmes Memorial Hospital Organization, Winona, MS Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2019 100%
Cori Bailey Individual Corporate OfficerCfo Dec 1, 2008 100%
W-2 Managing EmployeeCfo Dec 1, 2008 100%
Steven D Gammel Individual Corporate DirectorMedical Director Jul 31, 2009 100%
W-2 Managing EmployeeMedical Director Jul 31, 2009 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Tyler Holmes Memorial HospitalWinona, MS, CCN 251312 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2003
Tyler Holmes Memorial Hospital Swing BedWinona, MS, CCN 25Z312 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2003
Winona Family PracticeWinona, MS, CCN 258641 Rural health clinic 5% Or Greater Direct Ownership Interest Jun 1, 2019

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770681600000",
    "number": "1730367459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 WOODLAND DR",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "389671530",
            "telephone_number": "662-283-8205",
            "fax_number": "662-283-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 WOODLAND DR",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "389671530",
            "telephone_number": "662-283-8205",
            "fax_number": "662-283-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER HOLMES MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TYLER HOLMES MEMORIAL HOSPITAL",
        "enumeration_date": "2008-02-05",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "CORI",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-283-6126"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "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": "008203508",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "2070889",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8009711",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005330334",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007870552",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1497164446",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1730367459",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1730550419",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200007660",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "2163489",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08203508",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1659550127",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Family Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Crossroads Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Winona, MS

Sources for this page

Verify at the official NPI Registry.