NPIMap

Yalobusha General Hospital

Organization Active NPI Rural Health Clinic/Center · Oakland, MS

NPI 1942547161 · NPPES record last updated Jan 8, 2013

Key facts

NPI
1942547161
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
YALOBUSHA GENERAL HOSPITAL
Practice address
14101 Hickory St.
Oakland, MS 38948
Phone
(662) 473-1411
NPI assigned
Jan 8, 2013
Organization subpart
No

Authorized official

Name
Joe Meurrier
Title
Clinic Administrator
Phone
(662) 473-1411

Owners & managing parties with NPI records 5

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

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 15

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

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2056067Oakland Medical Clinic
14101 Hickory Street, Oakland, MS 38948		Certificate of waiverMar 20, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

Rural health clinic certification: CCN 258585

Legal name
YALOBUSHA GENERAL HOSPITAL
Doing business as
OAKLAND MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 13, 2013
Last certification
Dec 14, 2021
Ownership / control type
Non-profit – church related
Organization structure
Government · Non-profit
Enrollment address
14101 Hickory St
Oakland, MS 38948-2631
Related CCNs
250061

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Stephanie S Burns
Individual 		W-2 Managing Employee Jan 16, 2014
Jessica Embry
Individual 		Corporate Director
Administrator		 Jan 26, 2020
W-2 Managing Employee
Administrator		 Jan 26, 2020
Joe Meurrier
Individual 		Operational/Managerial Control
Clinic Administrator		 Apr 1, 2013
Yalobusha General Hospital
Organization · Oakland, MS 		5% Or Greater Direct Ownership Interest Apr 1, 2013 100%
Vanessa Carvan
Individual 		Operational/Managerial Control
Director of Reimbursement		 Apr 1, 2013

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Yalobusha General Hospital
Water Valley, MS · CCN 250061		 Hospital 5% Or Greater Direct Ownership Interest Sep 1, 1966
Yalobusha General Hospital Swing Bed
Water Valley, MS · CCN 25U061		 Hospital 5% Or Greater Direct Ownership Interest Sep 12, 1985
Odom Rural Health Clinic
Water Valley, MS · CCN 258538		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2007
Arrington Medical Clinic
Coffeeville, MS · CCN 258598		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 10, 2014

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130517000045 MS Part a Provider - Rural Health Clinic 4486601648 Practice locations: Oakland, MS

National Provider Directory

Tax ID family
Yalobusha General Hospi (16 organizations share this tax ID)

Locations

14101 Hickory St
Oakland, MS 38948
Phone (662) 473-1411

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

14101 Hickory St.
Oakland, MS 38948

Mailing address

14101 Hickory Street
Oakland, MS 38948

Other names

  • Oakland Medical Clinic Doing business as

Other providers in Oakland, MS

All providers in Oakland, MS · Rural Health Clinic/Center in Mississippi

Sources for this page

Verify at the official NPI Registry.