NPIMap

Region 12 Commission on Mental Health & Retardation Pine

Organization Active NPI Community/Retail Pharmacy · Hattiesburg, MS

NPI 1861645657 · NPPES record last updated Feb 16, 2017

Key facts

NPI
1861645657
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
07864/5.1 (MS)
Legal business name
REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE
Practice address
103 S 19TH Ave
Hattiesburg, MS 39401-6171
Phone
(601) 544-4641
Fax
(601) 450-4632
NPI assigned
Oct 24, 2008
Organization subpart
No

Authorized official

Name
Jerry Mayo
Title
Ceo
Phone
(601) 544-4641

Corporate family (same tax ID) 4

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

National Provider Directory

Tax ID family
Clearview Recovery Center (5 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 07864/5.1 MS Yes

Addresses

Primary practice location

103 S 19TH Ave
Hattiesburg, MS 39401-6171

Mailing address

103 S 19TH Ave
Hattiesburg, MS 39401-6171
Phone (601) 544-4641

Other identifiers

IdentifierTypeStateIssuer
2117558OtherPK

Other names

  • Pine Belt Mental Healthcare Resources Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 16, 2017.

{
    "created_epoch": "1224806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1861645657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S 19TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394016171",
            "telephone_number": "601-544-4641",
            "fax_number": "601-450-4632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S 19TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394016171",
            "telephone_number": "601-544-4641",
            "fax_number": "601-450-4632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-24",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-544-4641"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "07864/5.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117558",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Belt Mental Healthcare Resources",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

All providers in Hattiesburg, MS · Community/Retail Pharmacy in Mississippi

Sources for this page

Verify at the official NPI Registry.