NPIMap

Organization Active NPI

East Mississippi State Hospital

  • Multi-Specialty Clinic/Center
  • Meridian, MS
National Provider Identifier
1972689313
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
EAST MISSISSIPPI STATE HOSPITAL
Practice address
4555 Highland Park Drive
Meridian, MS 39307-2903
Phone
(601) 581-7562
Fax
(601) 581-7676
NPI assigned
Oct 27, 2006
Organization subpart
Yes
Parent organization
EAST MISSISSIPPI STATE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

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

Authorized official

Name
Mr. William Hamrick Entrekin
Title
Business Services Director
Phone
(601) 581-7969

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Nursing Facility/Intermediate Care Facility 313M00000X 1230 MS

Addresses

Primary practice location

4555 Highland Park Drive
Meridian, MS 39307-2903

Mailing address

P.O. Box 4128
West Station
Meridian, MS 39304-4128
Phone (601) 581-7562

Other identifiers 1

IdentifierTypeStateIssuer
00023122MedicaidMS

Other names 1

  • REGINALD P WHITE NURSING FACILITY Other name

National Provider Directory

National Provider Directory
Part of
East Mississippi State

Locations

1451 N Lakeland Dr
#P
Meridian, MS 39307
Phone (601) 581-7969

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1972689313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4128",
            "address_2": "WEST STATION",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393044128",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 HIGHLAND PARK DRIVE",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393072903",
            "telephone_number": "601-581-7562",
            "fax_number": "601-581-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MISSISSIPPI STATE HOSPITAL",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "ENTREKIN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HAMRICK",
        "authorized_official_title_or_position": "BUSINESS SERVICES DIRECTOR",
        "authorized_official_telephone_number": "601-581-7969",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MS",
            "license": "1230",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00023122",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REGINALD P WHITE NURSING FACILITY",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "REGINALD P WHITE NURSING FACILITY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.