NPIMap

Organization Active NPI

East Mississippi State Hospital

Doing business as Dental Clinic

  • General Practice Dentistry
  • Meridian, MS
National Provider Identifier
1841490612
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
31-136 Issued in MS
Legal business name
EAST MISSISSIPPI STATE HOSPITAL
Doing business as
Dental Clinic
Practice address
1818 College Drive
Reimbursement Dept.
Meridian, MS 39307-5429
Phone
(601) 581-7562
Fax
(601) 581-7676
NPI assigned
Jul 20, 2007
Last updated
May 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST MISSISSIPPI STATE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Charles Carlisle
Title
Hospital Director
Phone
(601) 581-7878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 31-136 MS Primary

Addresses

Primary practice location

1818 College Drive
Reimbursement Dept.
Meridian, MS 39307-5429

Mailing address

PO Box 4128
West Station
Meridian, MS 39304-4128
Phone (601) 581-7562

Other identifiers 1

IdentifierTypeStateIssuer
09422269MedicaidMS

Other names 1

  • DENTAL CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
East Mississippi State5 organizations share this tax ID, including this one
Part of
East Mississippi State

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1841490612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4128",
            "address_2": "WEST STATION",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393044128",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 COLLEGE DRIVE",
            "address_2": "REIMBURSEMENT DEPT.",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393075429",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "enumeration_date": "2007-07-20",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "HOSPITAL DIRECTOR",
        "authorized_official_telephone_number": "601-581-7878"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "31-136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09422269",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DENTAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DENTAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 12, 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.