Mississippi Band of Choctaw Indians
Organization Active NPI General Acute Care Hospital · Choctaw, MS
NPI 1790865780 · NPPES record last updated Jun 15, 2012
Key facts
- NPI
- 1790865780
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- Legal business name
- MISSISSIPPI BAND OF CHOCTAW INDIANS
- Practice address
- 210 Hospital Cir
Choctaw, MS 39350-6781 - Phone
- (601) 656-2211
- Fax
- (601) 663-7721
- NPI assigned
- Oct 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Phyllis J Anderson
- Title
- Tribal Chief
- Phone
- (601) 656-2211
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 2
Practitioners 72
-
Michelle S Atkinson, DNP
-
Brandie D Buckley, FNP
-
Johnny Lee Cosby, OD
-
Teresa K. Cumberland, FNP
-
Gregory Andrew Gordon, M.D.
-
Shannon Victoria Johnson, WHNP
-
Heather Patchin, WHNP
-
Leah Denise Phillips, FNP
-
Kelly Seid, M.D.
-
Donna Demetral Snow, CNP
-
Tiah Rae York, FNP-C
-
Nestor L. Olivo-Crespo, M.D.
-
Nathan Richard Randall, D.P.M.
-
Min S Kim, MD
-
Gwendolyn Denise Burnside, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, MS
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Choctaw Residential Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Oct 22, 1987 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040126000871 | TX | Part B Supplier - Clinic/Group Practice | 4385546662 |
Receives reassigned benefits from 71 practitioners 6 other NPIs on this enrollment Practice locations: Choctaw, MS; Philadelphia, MS; Conehatta, MS; Carthage, MS |
| O20100812000285 | MS | Part a Provider - Indian Health Services Facility | 4385546662 | Practice locations: Carthage, MS; Choctaw, MS; Conehatta, MS; Philadelphia, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Yes |
Addresses
Primary practice location
210 Hospital Cir
Choctaw, MS 39350-6781
Mailing address
210 Hospital Cir
Choctaw, MS 39350-6781
Phone (601) 656-2211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00020230 | Medicaid | MS |
Other names
- CHOCTAW HEALTH CENTER
Other providers in Choctaw, MS
- Mississippi Band of Choctaw Indians
- Mississippi Band of Choctaw Indians
- Mississippi Band of Choctaw Indians
- Mississippi Band of Choctaw Indians
- Mississippi Band of Choctaw Indians
- Mississippi Band of Choctaw Indians
- Abby Montgomery
- Jessica W Mooney
- Ms Band of Choctaw Indians
- Linda Murray
All providers in Choctaw, MS · General Acute Care Hospital in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2012. 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.