NPIMap

Organization Active NPI

Aaron E Henry Community Health

Doing business as M. J. Edwards Center

  • Federally Qualified Health Center (FQHC)
  • Coldwater, MS
National Provider Identifier
1841616265
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AARON E HENRY COMMUNITY HEALTH
Doing business as
M. J. Edwards Center
Practice address
643 W Service Dr
Coldwater, MS 38618-3822
Phone
(662) 624-4292
Fax
(662) 624-4354
NPI assigned
Mar 10, 2014
Last updated
Jun 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Authorized official

Name
Ms. Aurelia Jones-Taylor
Title
Chief Executive Officer
Phone
(662) 624-4292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

643 W Service Dr
Coldwater, MS 38618-3822

Mailing address

510 Highway 322
P O Box 1216
Clarksdale, MS 38614-4717
Phone (662) 624-2504

Other names 1

  • M. J. Edwards Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140924002279 MS Part A Provider - Federally Qualified Health Center (FQHC) 1153230560 Practice locations: Coldwater, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841616265. Details of each certification follow.

Federally qualified health center certification: CCN 251030

Legal name
AARON E HENRY COMMUNITY HEALTH
Doing business as
M. J. EDWARDS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 16, 2014
Last certification
Dec 16, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1949 in MS
Enrollment address
643W Service Dr
Coldwater, MS 38618-3822

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
25D2080432Aaron E Henry Community Health Services CNTR Inc643 West Service Drive, Coldwater, MS 38618Certificate of waiverJul 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Aaron E Henry Community Health18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Member organizations 1

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

Locations

643 W Service Dr
Coldwater, MS 38618
Phone (662) 233-5200

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tracey Rosebud Individual Corporate DirectorBoard Member Oct 15, 2013 100%
Raymond Cole Individual Corporate DirectorBoard Member May 11, 1994 100%
Orlando Paden Individual Corporate DirectorBoard Member Feb 20, 2012 100%
Lydia Rios Individual Corporate DirectorBoard Member May 7, 2010 100%
Larry Haynes Individual Corporate DirectorBoard Member Sep 21, 1989 100%
Aurelia Jones-Taylor Individual Corporate OfficerCeo Jun 5, 1989 100%
W-2 Managing Employee Jun 5, 1989 100%
Josephine Rhymes Individual Corporate DirectorBoard Member Jan 12, 1994 100%
Robert Jackson Individual Corporate DirectorBoard Member May 11, 2004 100%

Practitioners & affiliated clinicians

Practitioners 10

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": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1841616265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HIGHWAY 322",
            "address_2": "P O BOX 1216",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386144717",
            "telephone_number": "662-624-2504",
            "fax_number": "662-624-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 W SERVICE DR",
            "city": "COLDWATER",
            "state": "MS",
            "postal_code": "386183822",
            "telephone_number": "662-624-4292",
            "fax_number": "662-624-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AARON E HENRY COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "JONES-TAYLOR",
        "authorized_official_first_name": "AURELIA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "662-624-4292",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M. J. Edwards Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "M. J. Edwards Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coldwater, MS

Sources for this page

Verify at the official NPI Registry.