Leake County Board of Trustees

Primary specialty

Critical Access HospitalTaxonomy code 282NC0060X

License

11-187 Issued in MS

Legal business name

LEAKE COUNTY BOARD OF TRUSTEES

Doing business as

Leake Memorial Hospital

Practice address

310 Ellis St
Carthage, MS 39051-3809

Phone

(601) 267-1100

Fax

(601) 267-1211

NPI assigned

Dec 13, 2005

Last updated

Dec 30, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert Daniel Faulkner

Title

Administrator

Phone

(601) 267-1432

Specialties & licenses 3

Addresses

Other names 1

• Leake Memorial Hospital Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1831174804. Details of each certification follow.

• CCN 250030 Hospital · Terminated · Name & address match · Details
• CCN 250154 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 250030

Legal name

LEAKE COUNTY MEMORIAL HOSP

Certification status

Terminated Voluntary: merger or closure, Jan 7, 2003

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Feb 26, 1999

Beds

42

Ownership / control type

Private (not for profit)

Facility address

310 Ellis St P O Box 557
Carthage, MS 39051

Hospital certification: CCN 250154

Legal name

LEAKE COUNTY MEMORIAL HOSPITAL

Certification status

Terminated Other: provider status change, Dec 31, 2003

Provider type (POS)

Hospital – Short-term

Participating since

Jan 15, 2003

Last certification

Jan 14, 2003

Beds

42

Ownership / control type

Local

Facility address

310 Ellis Street
Carthage, MS 39051

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230595200000",
    "number": "1831174804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 ELLIS ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390513809",
            "telephone_number": "601-267-1100",
            "fax_number": "601-267-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 ELLIS ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390513809",
            "telephone_number": "601-267-1100",
            "fax_number": "601-267-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAKE COUNTY BOARD OF TRUSTEES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2008-12-30",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-267-1432",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MS",
            "license": "11-187",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "11-187",
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MS",
            "license": "11-187",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leake Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tommie K Jones, C.F.N.P.
• Janet Kelly
• KW Registered Dietitian Nutritionist P.L.L.C.
• Charlotte Rena Laster, CPT, X-RAY TECH, CMA
• Jessica Sharleen Lavender, M.D.
• Leake County School District
• Leake Emergency Group, LLC
• Leake Extended Care Facility
• Leake LTC, LLC (Carthage Health & Rehab Center)
• Lifecare EMS LLC (Lifecare EMS)

• Critical Access Hospital in Carthage, MS
• Providers in Carthage, MS by specialty
• Critical Access Hospital in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; 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.