NPIMap

Organization Active NPI

Leake County Board of Trustees

  • Critical Access Hospital
  • Carthage, MS
National Provider Identifier
1831174804
Registry record updated Dec 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
11-187 Issued in MS
Legal business name
LEAKE COUNTY BOARD OF TRUSTEES
Practice address
310 Ellis St
Carthage, MS 39051-3809
Phone
(601) 267-1100
Fax
(601) 267-1211
NPI assigned
Dec 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2008

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

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 11-187 MS
Critical Access Hospital 282NC0060X 11-187 MS Primary
Rural Acute Care Hospital 282NR1301X 11-187 MS

Addresses

Primary practice location

310 Ellis St
Carthage, MS 39051-3809

Mailing address

310 Ellis St
Carthage, MS 39051-3809
Phone (601) 267-1100

Other identifiers 5

IdentifierTypeStateIssuer
0220808MedicaidMS
0220809MedicaidMS
0230186MedicaidMS
9016232MedicaidMS
9016253MedicaidMS

Other names 1

  • Leake Memorial Hospital Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0220808",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0220809",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230186",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9016232",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9016253",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leake Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carthage, MS

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.