NPIMap

Organization Active NPI

Copiah County Medical Center

  • Critical Access Hospital
  • Hazlehurst, MS
National Provider Identifier
1972826121
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
11-164 Issued in MS
Legal business name
COPIAH COUNTY MEDICAL CENTER
Practice address
27190 Highway 28
Hazlehurst, MS 39083-2224
Phone
(601) 574-7000
Fax
(601) 574-7216
NPI assigned
Mar 2, 2010
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Halle Russell
Title
Business Office Director
Phone
(601) 574-7233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 11-164 MS Primary

Addresses

Primary practice location

27190 Highway 28
Hazlehurst, MS 39083-2224

Mailing address

27190 Highway 28
Hazlehurst, MS 39083-2224
Phone (601) 574-7000

Other identifiers 1

IdentifierTypeStateIssuer
00029115MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080612000572 MS Part A Provider - Critical Access Hospital 2062583487 Practice locations: Hazlehurst, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972826121. Details of each certification follow.

Hospital certification: CCN 25Z327

Legal name
COPIAH COUNTY MEDICAL CENTER
Doing business as
COPIAH COUNTY MEDICAL CENTER
Organization structure
OtherNon-profit
Incorporated
Sep 11, 1950 in MS
Enrollment address
27190 Highway 28
Hazlehurst, MS 39083-2224
Other Hospital Practice Location

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
Kliesch Med Assoc PA7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Copiah County Medical Center Organization, Hazlehurst, MS Medical provider/supplier, Non-profit Operational/Managerial Control Jan 1, 2006 100%
Kelli Barfield Individual W-2 Managing EmployeeExecutive Assistant-Administration Oct 15, 2021
Kortney Gaddy Individual Corporate DirectorCfo Apr 1, 2022
W-2 Managing Employee Apr 1, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Copiah County Medical CenterHazlehurst, MS, CCN 251327 Hospital Operational/Managerial Control (100%) Jan 1, 2006
Crystal Springs ClinicCrystal Springs, MS, CCN 258675 Rural health clinic Other May 1, 2022

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1972826121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27190 HIGHWAY 28",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390832224",
            "telephone_number": "601-574-7000",
            "fax_number": "601-574-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27190 HIGHWAY 28",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390832224",
            "telephone_number": "601-574-7000",
            "fax_number": "601-574-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPIAH COUNTY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "HALLE",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "601-574-7233"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "11-164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00029115",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazlehurst, MS

Sources for this page

Verify at the official NPI Registry.