Promise Hospital of Vicksburg Inc

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

22-334 Issued in MS

Legal business name

PROMISE HOSPITAL OF VICKSBURG INC

Practice address

2100 Highway 61 N FL 6
Vicksburg, MS 39183

Phone

(601) 883-3265

Fax

(601) 883-3279

NPI assigned

Mar 22, 2006

Organization subpart

No

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

Authorized official

Name

Mr. James Hopwood

Title

Cfo

Phone

(561) 869-3100

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 250158

Legal name

PROMISE SPECIALTY HOSPITAL OF VICKSBURG

Certification status

Terminated Other: provider status change, Jun 30, 2004

Provider type (POS)

Hospital – Short-term

Participating since

Dec 5, 2003

Last certification

Dec 5, 2003

Beds

33

Ownership / control type

Private (for profit)

Facility address

1111 North Frontage Road 2D Floor
Vicksburg, MS 39180

Locations

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1932168416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 YAMATO ROAD",
            "address_2": "3RD FLOOR",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "33431",
            "telephone_number": "561-869-3100",
            "fax_number": "561-826-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N FL 6",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39183",
            "telephone_number": "601-883-3265",
            "fax_number": "601-883-3279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 N Frontage Rd",
            "address_2": "2ND FLOOR",
            "address_purpose": "LOCATION",
            "city": "Vicksburg",
            "state": "MS",
            "postal_code": "391805102",
            "country_code": "US",
            "telephone_number": "601-619-3526",
            "fax_number": "601-619-3071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROMISE HOSPITAL OF VICKSBURG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2018-05-16",
        "status": "A",
        "authorized_official_last_name": "HOPWOOD",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "561-869-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "MS",
            "license": "22-334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS STATE EMPLOYEE",
            "identifier": "000021834",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS REGULAR PROV #",
            "identifier": "000020813",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Long Term Care Hospital in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Long Term Care Hospital in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.