Central Mississippi Health Services, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Tougaloo, MS
NPI 1982746087 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1982746087
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL MISSISSIPPI HEALTH SERVICES, INC
- Practice address
- 500 W County Line Rd
Tougaloo, MS 39174-9700 - Phone
- (601) 948-5574
- Fax
- (601) 353-7070
- NPI assigned
- Feb 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Terry Johnson
- Title
- Human Resource Manager
- Phone
- (601) 948-5572
Other NPIs on the same Medicare enrollment 4
Practitioners 15
-
Latoya P. Johnson, PA-C
-
Zina Darcel Lee, M.D.
-
Zipora Martin-Brown, FNP-C
-
Obie M. McNair, M.D.
-
Denetta Ross, FNP-C
-
Janice Bacon, MD
-
Morlyn Russell, FNPC, BSN, RN
-
Eurekia C Samuel, NP
-
Edith Faye Smith Rayford, M.D.
-
Robert Smith, M.D.
-
Tamara Cassie Winfield, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D1106015 | Central Mississippi Health Services | Provider-performed microscopy | Oct 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040225000632 | MS | Part B Supplier - Clinic/Group Practice | 2961398029 |
Receives reassigned benefits from 24 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jackson, MS; Tougaloo, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
500 W County Line Rd
Tougaloo, MS 39174-9700
Mailing address
1134 Winter St
Jackson, MS 39204-2841
Phone (601) 948-5574
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00809719 | Medicaid | MS |
Other providers in Tougaloo, MS
- Central Mississippi Civic Improvement Association, Inc
- Eppsinstituteforhealthyfamilyandcommunityliving,LLC
- Premier Rehab
- Morlyn Russell
- V a North
All providers in Tougaloo, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.