Mississippi Behavioral Health Treatment Institute Incorporated Inc
Organization Active NPI Psychiatry Physician · Bogue Chitto, MS
NPI 1811367113 · NPPES record last updated Mar 4, 2024
Key facts
- NPI
- 1811367113
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- MISSISSIPPI BEHAVIORAL HEALTH TREATMENT INSTITUTE INCORPORATED INC
- Practice address
- 394 Imperial LN SW
Bogue Chitto, MS 39629-8231 - Phone
- (601) 996-1758
- Fax
- (601) 797-8406
- NPI assigned
- Sep 29, 2015
- Organization subpart
- No
Authorized official
- Name
- Khari Abayomi Omolara, MD
- Title
- Medical Director
- Phone
- (601) 996-1758
Practitioners 2
-
Khari Abayomi Omolara, M.D.
-
Markesia Kijana Council, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160323001364 | MS | Part B Supplier - Clinic/Group Practice | 6002113784 |
Receives reassigned benefits from 1 practitioner Practice locations: Natchez, MS; Bogue Chitto, MS |
| O20230728003119 | LA | Part B Supplier - Clinic/Group Practice | 6002113784 |
Receives reassigned benefits from 1 practitioner Practice locations: Vidalia, LA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
394 Imperial LN SW
Bogue Chitto, MS 39629-8231
Mailing address
PO Box 3129
Brookhaven, MS 39603-7129
Phone (601) 996-1758
Other practice location 1
317 Highland Blvd
Suite S
Natchez, MS 39120-4634
Phone (601) 445-1922
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2522183 | Medicaid | LA | |
| 3663198 | Medicaid | LA | |
| 000126454 | Medicaid | MS | |
| 009120058 | Medicaid | MS |
Other names
- Mississippi Behavioral Health Treatment Institute
Other providers in Bogue Chitto, MS
- Family Health Care Clinic, Inc.
- Jeffrey Gatlin
- Sarah Guthrie
- Sarabeth Hall
- M3 Medical Services LLC
- Khari Abayomi Omolara
- Rachel Kennedy Powell
- Andrea Quin
- Beverly N Ray
- Jo Ann MC Kenzie Spears
All providers in Bogue Chitto, MS · Psychiatry Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.