Pontotoc Health Services, Inc.
Organization Active NPI Critical Access Hospital · Pontotoc, MS
NPI 1962512871 · NPPES record last updated Jan 20, 2025
Key facts
- NPI
- 1962512871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 16-091 (MS)
- Legal business name
- PONTOTOC HEALTH SERVICES, INC.
- Practice address
- 176 S Main St
Pontotoc, MS 38863-3311 - Phone
- (662) 488-7640
- Fax
- (662) 488-7675
- NPI assigned
- Aug 30, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- PONTOTOC HEALTH SERVICES, INC.
Authorized official
- Name
- Bruce Toppin
- Title
- Corporate Secretary
- Phone
- (662) 377-4229
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Facilities with the same owner 33
Practitioners 110
-
Holly N Bell, APRN
-
Malorie Devaughn, ACNPC-AG
-
Curtis Ross Glidewell, M.D.
-
Samuel Joseph Holdiness, M.D.
-
Jennifer Dawn Lowery, M.D.
-
Brian D McCoy, MD
-
Scotty P Reed, M.D.
-
Kara Rushing, FNP-C
-
Kiley Patrick Shafer, M.D.
-
Andrea J Warren, DO
-
Timothy R Watson, FNP-C
-
Brenda Elain Worthey, FNP-C
-
Justin Smith, M.D.
-
Jeffrey Ballard, APRN,FNP-BC
-
Christopher Ryan Billsby, D.O.
-
John Browning, M.D.
Affiliated clinicians 3
-
Ralph Sumner Abraham IV, M.D.
-
Charles Frye, M.D.
-
Abdalaziz Tabash, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Hospital certification: CCN 25Z308
- Legal name
- PONTOTOC HEALTH SERVICES, INC.
- Doing business as
- PONTOTOC HEALTH SERVICES-CAH-SWING BED
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 176 S Main St
Pontotoc, MS 38863-3311
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Leslia D Carter |
W-2 Managing Employee | Nov 1, 2014 | |
| North Mississippi Health Services Inc |
5% Or Greater Direct Ownership Interest | Sep 21, 1987 | |
| Bruce J Toppin |
Corporate Officer |
Nov 1, 1997 | |
| Sharon D Nobles |
Corporate Officer |
Apr 4, 2017 | |
| Michael S Spees |
Operational/Managerial Control |
Feb 1, 2014 | |
| Ernie Wright |
Corporate Director |
Aug 13, 2022 | |
| Miriam Clark |
Corporate Director |
Aug 13, 2022 | |
| Scott Uithoven |
Corporate Director |
Aug 13, 2022 | |
| Conwell Duke |
Corporate Director |
Aug 13, 2022 | |
| David High |
Corporate Director |
Aug 13, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040719001336 | MS | Part B Supplier - Clinic/Group Practice | 6002895356 |
Receives reassigned benefits from 104 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ecru, MS; New Albany, MS; Pontotoc, MS |
| O20220725001376 | MS | Part a Provider - Critical Access Hospital | 6002895356 | Practice locations: Pontotoc, MS |
National Provider Directory
- Part of
- Pontotochealthservicesinc
Locations
345 Highway 15 N
Pontotoc, MS 38863
Phone (662) 489-7430
30 W Reynolds St
Pontotoc, MS 38863
Phone (662) 488-7640
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 16-091 | MS | Yes |
Addresses
Primary practice location
176 S Main St
Pontotoc, MS 38863-3311
Mailing address
176 S Main St
Pontotoc, MS 38863-3311
Phone (662) 488-7640
Other names
- Pontotoc Health Services CAH - Swing Bed
Other providers in Pontotoc, MS
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- Pontotoc Health Services, Inc.
- Pontotoc Health Services, Inc.
- Pontotoc Health Services, Inc.
- Pontotoc Health Services, Inc.
- Pontotoc LTC, Inc
- Pototoc Health Services Inc
- Kenneth E Prewett
- PT Mobile, LLC
- Keri Connelly Purser
All providers in Pontotoc, MS · Critical Access Hospital in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.