NPIMap

Organization Active NPI

Southern Women's Health, PLLC

Doing business as Women's Pavilion of South Mississippi

  • Obstetrics & Gynecology Physician
  • Ellisville, MS
National Provider Identifier
1831275189
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SOUTHERN WOMEN'S HEALTH, PLLC
Doing business as
Women's Pavilion of South Mississippi
Practice address
1242 Hwy 29 North
Ellisville, MS 39437
Phone
(601) 719-0003
Fax
(601) 719-0009
NPI assigned
Oct 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

Name
Holley Johnson
Title
Administrator
Phone
(601) 450-9425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1242 Hwy 29 North
Ellisville, MS 39437

Mailing address

6524 U S Highway 98
Hattiesburg, MS 39402-8569
Phone (601) 268-9393

Other identifiers 1

IdentifierTypeStateIssuer
05285762MedicaidMS

Other names 1

  • Women's Pavilion of South Mississippi Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726001079 MS Part B Supplier - Clinic/Group Practice 5799769535 Receives reassigned benefits from 14 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellisville, MS; Hattiesburg, MS

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1059871Southern Women's Health1242 Hwy 29 N, Ellisville, MS 39437Provider-performed microscopyOct 8, 2026

National Provider Directory

National Provider Directory
Tax ID family
Southern Women's Health PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1162166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1831275189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6524 U S HIGHWAY 98",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028569",
            "telephone_number": "601-268-9393",
            "fax_number": "601-268-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1242 HWY 29 NORTH",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "39437",
            "telephone_number": "601-719-0003",
            "fax_number": "601-719-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN WOMEN'S HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HOLLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-450-9425"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05285762",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Women's Pavilion of South Mississippi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellisville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.