NPIMap

Organization Active NPI

Mississippi Behavioral Health Treatment Institute Incorporated Inc

Doing business as Mississippi Behavioral Health Treatment Institute

  • Psychiatry Physician
  • Bogue Chitto, MS
National Provider Identifier
1811367113
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MISSISSIPPI BEHAVIORAL HEALTH TREATMENT INSTITUTE INCORPORATED INC
Doing business as
Mississippi Behavioral Health Treatment Institute
Practice address
394 Imperial LN SW
Bogue Chitto, MS 39629-8231
Phone
(601) 996-1758
Fax
(601) 797-8406
NPI assigned
Sep 29, 2015
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Khari Abayomi Omolara, MDNPI 1477669380
Title
Medical Director
Phone
(601) 996-1758

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

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 names 1

  • Mississippi Behavioral Health Treatment Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1811367113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3129",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396037129",
            "telephone_number": "601-996-1758",
            "fax_number": "601-797-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 IMPERIAL LN SW",
            "city": "BOGUE CHITTO",
            "state": "MS",
            "postal_code": "396298231",
            "telephone_number": "601-996-1758",
            "fax_number": "601-797-8406"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "317 Highland Blvd",
            "address_2": "Suite S",
            "address_purpose": "LOCATION",
            "city": "Natchez",
            "state": "MS",
            "postal_code": "391204634",
            "country_code": "US",
            "telephone_number": "601-445-1922",
            "fax_number": "601-445-1923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSISSIPPI BEHAVIORAL HEALTH TREATMENT INSTITUTE INCORPORATED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-29",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "OMOLARA",
        "authorized_official_first_name": "KHARI",
        "authorized_official_middle_name": "ABAYOMI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-996-1758",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi Behavioral Health Treatment Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mississippi Behavioral Health Treatment Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bogue Chitto, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.