ELLISVILLE STATE SCHOOL (NPI# 1164582821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164582821 |
| Entity Type | Organization |
| Organization Name | ELLISVILLE STATE SCHOOL |
| Other Organization Name | EPSDT |
| Practice Address |
1101 Highway 11 S Ellisville MS 39437-4443 |
| Practice Telephone | 6014779384 |
| Practice Fax Number | 6014775700 |
| Mailing Telephone | 6014779384 |
| Mailing Fax Number | 6014775700 |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2008-06-17 |
| Authorized Official Name | DR. SUZIE LASSITER (DIRECTOR OF FACILITY) |
| Authorized Official Telephone | 6014779384 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 374700000X | Technician | ESS-BMR | MS | Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09015542 | 05 |
| Other Name | Type Code |
|---|---|
| EPSDT | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568468080 | Ellisville State School | Clinic/Center | 1101 Hwy 11 S, Ellisville, MS 39437-4444 | 2005-06-21 |
| 1285947408 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2010-07-16 |
| 1811135718 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-01-30 |
| 1578668901 | Ellisville State School | Pharmacy | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-13 |
| 1720181191 | Ellisville State School | Health Maintenance Organization | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ELLISVILLE STATE SCHOOL | 1101 Highway 11 S Eville, Ellisville, MS 39437-4443 |
| Street Address |
1101 HIGHWAY 11 S |
| City | ELLISVILLE |
| State | MS |
| Zip Code | 39437-4443 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255364337 | Joseph Rodney Moring | Emergency Medicine | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-07-09 |
| 1700125895 | Breanna L Bonner | Nurse Practitioner | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2013-02-08 |
| 1992865653 | Home Community Base Waiver - Ess | Technician | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-11 |
| 1306914700 | Hillside | Nursing Facility/Intermediate Care Facility | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-01 |
| 1205904604 | Pecan Grove | Nursing Facility/Intermediate Care Facility | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-01 |
| 1598833998 | Paul D. Cotten | Nursing Facility/Intermediate Care Facility | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-01 |
| 1013085414 | Ellisville State School Dental | Dentist | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-01 |
| 1508962101 | Lisa Graham Blesse | Nurse Practitioner | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-15 |
| 1578668901 | Ellisville State School | Pharmacy | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-13 |
| 1720181191 | Ellisville State School | Health Maintenance Organization | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227759 | Courtney J. Sims | Nurse Practitioner | 80 Hal Crocker Road, Ellisville, MS 39437 | 2020-02-19 |
| 1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
| 1972851814 | Dental Group of Ellisville, Pllc | Dentist | 97 Hal Crocker Road, Ellisville, MS 39437 | 2012-08-27 |
| 1891920518 | Amy E Young | Speech-Language Pathologist | 471 Hwy 590, Ellisville, MS 39437 | 2009-05-26 |
| 1053486852 | Natalia Angelia Stevenson | Nurse Practitioner | Ellisville State School, 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-11-21 |
| 1831275189 | Womens Pavilion of South Mississippi, Pllc | Obstetrics & Gynecology | 1242 Hwy 29 North, Ellisville, MS 39437 | 2006-10-30 |
| 1861578635 | Jennifer Reeder Mascagni | Nurse Practitioner | 1203 Ave B Ste 200, Ellisville, MS 39437 | 2006-10-27 |
| 1851499982 | Kathleen Frances Mccoy | Physical Therapist | 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-09-20 |
| 1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
| 1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
| Find all providers in zip 39437 | ||||
| Taxonomy Code | 374700000X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| (1) A person with specialized training in a narrow field of expertise whose occupation requires training and is skilled in specific technical processes and procedures. (2) An individual having special skill or practical knowledge in an area, such as operation and maintenance of equipment or performance of laboratory procedures involving biochemical analyses. Special technical qualifications are normally required, though an increasing number or technicians also possess university degrees in science, and occasionally doctorate degrees. The distinction between technician and technologist in the health care field is not always clear. |
| Notes: Sources: (1) Rhea, Ott, and Shafritz, The Facts on File Dictionary of Health Care Management, New York: Facts on File Publications, 1988; Dorland’s Illustrated Medical Dictionary, 26th Edition, Philadelphia: W.B. Saunders Company, 1981 and Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1984. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 776. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972120525 | Tomieko Threadgill | Technician | 13873 Lorado Dr Apt 178, Gulfport, MS 39503-4681 | 2020-06-30 |
| City | ELLISVILLE |
| Zip Code | 39437 |
Please comment or provide details below to improve the information on ELLISVILLE STATE SCHOOL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.