NPIMap

Organization Active NPI

Ms State Dept of Helth

  • Women's Health Nurse Practitioner
  • Meridian, MS
National Provider Identifier
1841370749
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
R505307 Issued in MS
Legal business name
MS STATE DEPT OF HELTH
Practice address
3128 8TH St
Meridian, MS 39301-4753
Phone
(601) 482-3171
NPI assigned
Oct 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Mark Phillips
Title
Clams Adjuster
Phone
(601) 576-7566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X R505307 MS Primary

Addresses

Primary practice location

3128 8TH St
Meridian, MS 39301-4753

Mailing address

769 Crane Rd
Carthage, MS 39051-6110
Phone (601) 267-5027

Other identifiers 1

IdentifierTypeStateIssuer
00124030MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Ms State Dept Clinical Lab126 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841370749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "769 CRANE RD",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390516110",
            "telephone_number": "601-267-5027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3128 8TH ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014753",
            "telephone_number": "601-482-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MS STATE DEPT OF HELTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CLAMS ADJUSTER",
        "authorized_official_telephone_number": "601-576-7566",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MS",
            "license": "R505307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00124030",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.