Hollandale Family Care

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

901794 Issued in MS

Legal business name

HOLLANDALE FAMILY CARE

Practice address

1257 Highway 61 S
Hollandale, MS 38748-3864

Phone

(662) 827-2214

NPI assigned

Oct 31, 2016

Last updated

Oct 31, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

DELTA HEART AND VASCULARAs reported in NPPES

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

Authorized official

Name

Mr. Stanley J McGaugh

Title

Office Manager

Phone

(662) 335-0183

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790237345. Details of each certification follow.

• CCN 253940 Rural health clinic · Active · Name & address match · Details

Rural health clinic certification: CCN 253940

Legal name

HOLLANDALE FAMILY CARE PC ( CLOSED )

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 21, 1994

Last certification

Nov 2, 2018

Ownership / control type

2B

Most recent change of ownership

Dec 31, 2005 (1 total)

Facility address

1257 Highway 61 South
Hollandale, MS 38748

Part of

Delta Heart Vascular

Practitioners 2

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.

• Susan Caselli, CFNP

  • Family Medicine Physician
  • Rolling Fork, MS
  • NPI 1962406959
  NPD (past)
• Pamela Ann Bariola, FNP-BC

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1598800237
  NPD (past)

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

{
    "created_epoch": "1477872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477872000000",
    "number": "1790237345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "HOLLANDALE",
            "state": "MS",
            "postal_code": "387480247",
            "telephone_number": "662-827-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1257 HIGHWAY 61 S",
            "city": "HOLLANDALE",
            "state": "MS",
            "postal_code": "387483864",
            "telephone_number": "662-827-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLANDALE FAMILY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DELTA HEART AND VASCULAR",
        "enumeration_date": "2016-10-31",
        "last_updated": "2016-10-31",
        "status": "A",
        "authorized_official_last_name": "MCGAUGH",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-335-0183",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "901794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sylvia Cope Duncan, LPC
• Ken J Gailes, PT
• Blythe Anne Hamburg, P-LPC
• Senthan Harris
• Thomas Hassett, PHARMACISTS
• Hollandale Family Care, P.C.
• Hollandale Primary Care, Inc.
• Hollandale School District
• Home Management Home Maker Services
• Patricia Ann Hunter

• Family Nurse Practitioner in Hollandale, MS
• Providers in Hollandale, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.