NPIMap

Organization Active NPI

Freedom Hospital of Magnolia LLC

Doing business as Beacham Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Magnolia, MS
National Provider Identifier
1942501507
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
16-275 Issued in MS
Legal business name
FREEDOM HOSPITAL OF MAGNOLIA LLC
Doing business as
Beacham Memorial Hospital
Practice address
205 N Cherry St
Magnolia, MS 39652-2819
Phone
(601) 783-2353
Fax
(601) 783-9003
NPI assigned
Nov 12, 2010
Last updated
May 10, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
FREEDOM HOSPITAL OF MAGNOLIA LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2016

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

Authorized official

Name
Mr. Timothy J Reed
Title
Administrator/Ceo
Phone
(337) 802-1336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 16-275 MS Primary

Addresses

Primary practice location

205 N Cherry St
Magnolia, MS 39652-2819

Mailing address

PO Box 351
Magnolia, MS 39652-0351
Phone (601) 783-2353

Other identifiers 3

IdentifierTypeStateIssuer
250049MedicaidMS
00020043OtherBLUE CROSS
000080027OtherMSBLUE CROSS

Other names 1

  • Beacham Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160314001096 MS Part A Provider - Hospital 4082910393 Practice locations: Magnolia, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942501507. Details of each certification follow.

Hospital certification: CCN 25U049

Legal name
FREEDOM HOSPITAL OF MAGNOLIA LLC
Doing business as
BEACHAM MEMORIAL HOSPITAL
Organization structure
LLCProprietary
Incorporated
Jan 14, 2016 in LA
Enrollment address
205 N Cherry St
Magnolia, MS 39652-2819
Hospital Swing-Bed Unit
Hospital subgroups
Acute care, Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Freedom Hospital of Magnolia LLC4 organizations share this tax ID, including this one
Part of
Freedom Hospital of Magnolia LLC

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Lucius M Lampton Individual Contracted Managing EmployeeMD; Jul 17, 1995
Michael T. Goff Individual W-2 Managing EmployeeAd; Apr 11, 2024
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Aug 14, 2019 50%
Tara Cylyce Reed Individual Contracted Managing Employee Mar 1, 2016
Timothy Jason Reed Individual 5% Or Greater Direct Ownership Interest Mar 1, 2016 50%
Corporate OfficerCeo Mar 1, 2016
Operational/Managerial ControlCeo Mar 1, 2016
Azizah Verrett Individual Contracted Managing Employee Mar 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1942501507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 351",
            "city": "MAGNOLIA",
            "state": "MS",
            "postal_code": "396520351",
            "telephone_number": "601-783-2353",
            "fax_number": "601-783-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N CHERRY ST",
            "city": "MAGNOLIA",
            "state": "MS",
            "postal_code": "396522819",
            "telephone_number": "601-783-2353",
            "fax_number": "601-783-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEDOM HOSPITAL OF MAGNOLIA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREEDOM HOSPITAL OF MAGNOLIA LLC",
        "enumeration_date": "2010-11-12",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "337-802-1336",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MS",
            "license": "16-275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250049",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00020043",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000080027",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacham Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Magnolia, MS

Sources for this page

Verify at the official NPI Registry.