EAST MISSISSIPPI STATE HOSPITAL (NPI# 1629394853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629394853 |
| Entity Type | Organization |
| Organization Name | EAST MISSISSIPPI STATE HOSPITAL |
| Other Organization Name | JAMES T. CHAMPION NURSING FACILITY |
| Practice Address |
4555 Highland Park Dr Meridian MS 39307-5429 |
| Mailing Address |
Po Box 4128 Meridian MS 39304-4128 |
| Practice Telephone | 6015817600 |
| Practice Fax Number | 6015817676 |
| Mailing Telephone | 6015817600 |
| Mailing Fax Number | 6015817676 |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2020-05-12 |
| Authorized Official Name | CHARLES CARLISLE (HOSPITAL DIRECTOR) |
| Authorized Official Telephone | 6015817878 |
| Is Organization Subpart | Y |
| Parent Organization Name | EAST MISSISSIPPI STATE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 1034 | MS | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 01831556 | 05 |
| Other Name | Type Code |
|---|---|
| James T. Champion Nursing Facility | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407269756 | East Mississippi State Hospital | Psychiatric Unit | 1401 College Dr, Meridian, MS 39307-5345 | 2014-06-04 |
| 1972689313 | East Mississippi State Hospital | Nursing Facility/Intermediate Care Facility | 4555 Highland Park Drive, Meridian, MS 39307-2903 | 2006-10-27 |
| 1346522653 | East Mississippi State Hospital | Clinic/Center | 1818 College Drive, Meridian, MS 39307-5429 | 2011-09-13 |
| 1225342173 | East Mississippi State Hospital | Psychiatric Hospital | 4555 Highland Park Drive, Meridian, MS 39307 | 2010-08-03 |
| 1841490612 | East Mississippi State Hospital | Dentist | 1818 College Drive, Reimbursement Dept., Meridian, MS 39307-5429 | 2007-07-20 |
| 1649323254 | East Mississippi State Hospital | Psychiatric Hospital | 4555 Highland Park Dr, Meridian, MS 39307 | 2007-01-18 |
| Street Address |
4555 HIGHLAND PARK DR |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39307-5429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740349257 | Hermogenes V Thomas | General Practice | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2006-12-08 |
| 1609232123 | Vickie L Warren | Nurse Practitioner | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2016-01-13 |
| 1326458837 | Marcy Tingle | Pharmacist | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2014-05-06 |
| 1447660956 | Donald Mckay | Pharmacist | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2014-05-06 |
| 1356689640 | Angela Marshon Mars | Counselor | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2013-01-22 |
| 1891059184 | Curtis Lee Jones | Social Worker | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2012-07-02 |
| 1558679902 | Physician Group | Clinic/Center | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2010-09-20 |
| 1649587460 | Stella Elizabeth Gervin-ward | Social Worker | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2010-09-01 |
| 1093038234 | Magnolia Clinic | Clinic/Center | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2010-03-02 |
| 1235373663 | Kim Elliot Nagel | Psychiatry & Neurology | 4555 Highland Park Dr, Meridian, MS 39307-5429 | 2009-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841824232 | Erica Sheree Smith | Registered Nurse | 1818 College Dr, Meridian, MS 39307 | 2020-02-25 |
| 1518481480 | Derrick Pringle | Social Worker | 110 48th Ave, Meridian, MS 39307 | 2017-08-01 |
| 1821519547 | Leslie Rutkowski | Student in an Organized Health Care Education/Training Program | 2514 67th Avenue Loop Suite 112, Meridian, MS 39307 | 2017-07-03 |
| 1811254931 | Meridian Community College | Dentist | 910 Highway 19 North, Meridian, MS 39307 | 2012-04-13 |
| 1548533672 | Carvan Lorraine Carter | Counselor | 1807 39th Pl, Meridian, MS 39307 | 2012-02-21 |
| 1699921148 | Sara B Smith | Counselor | 1415 College Drive, Meridian, MS 39307 | 2008-08-15 |
| 1285856112 | Jan Parr Boggs | Psychologist | 1508 37th Avenue, Meridian, MS 39307 | 2007-05-02 |
| 1720694029 | Michelle Gomez Dickerson | Registered Nurse | 1818 College Drive, Meridian, MS 39307 | 2020-09-22 |
| 1770116030 | Briana Shanee Brunson | Nurse Practitioner | 1818 College Drive, Meridian, MS 39307 | 2020-02-14 |
| 1619507407 | Brenda A Thompson | Nurse Practitioner | 1818 College Drive, Meridian, MS 39307 | 2020-01-21 |
| Find all providers in zip 39307 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699108860 | Holistic Geriatric Care LLC | Nursing Facility/Intermediate Care Facility | 10026 Lizelia Rd, Meridian, MS 39305-9595 | 2013-08-12 |
| 1972689313 | East Mississippi State Hospital | Nursing Facility/Intermediate Care Facility | 4555 Highland Park Drive, Meridian, MS 39307-2903 | 2006-10-27 |
| 1306080320 | Meridian Helping Hands Inc | Nursing Facility/Intermediate Care Facility | 1015 N Main, Meridian, TX 76665-4632 | 2009-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467842641 | Crossroads Adult Day Care | Nursing Facility/Intermediate Care Facility | 519 S Church St, Brookhaven, MS 39601-3807 | 2015-01-27 |
| 1538492111 | Iva Ward LLC | Nursing Facility/Intermediate Care Facility | 711 Melrose Montebello Pkwy, Natchez, MS 39120-4924 | 2009-09-14 |
| 1295961969 | River Oaks Management, LLC | Nursing Facility/Intermediate Care Facility | 501 Highway 80 E, Brandon, MS 39042-3257 | 2009-06-08 |
| 1063697340 | North Bolivar School District | Nursing Facility/Intermediate Care Facility | 615 School Street, Duncan, MS 38740 | 2008-01-04 |
| 1659555761 | Tallahatchie General Hospital and Extended Care Facility | Nursing Facility/Intermediate Care Facility | 201 South Market Street, Charleston, MS 38921 | 2007-12-26 |
| 1568683498 | Whitfield Nursing Home, Inc. | Nursing Facility/Intermediate Care Facility | 2101 Proper St, Corinth, MS 38834-5247 | 2007-05-01 |
| 1265656391 | Gilberto Patino | Nursing Facility/Intermediate Care Facility | 419 Elizabeth Drive, Leakesville, MS 39451 | 2007-04-12 |
| 1013048453 | Bruce Nursing Center, Inc. | Nursing Facility/Intermediate Care Facility | 176 Hwy 9 South, Bruce, MS 38915 | 2007-03-08 |
| 1326178203 | Smith County Ltc, LLC | Nursing Facility/Intermediate Care Facility | 309 Magnolia Drive, Raleigh, MS 39153 | 2007-03-07 |
| 1346378387 | Care Center of Clinton | Nursing Facility/Intermediate Care Facility | 1251 Pinehaven Rd, Clinton, MS 39056-3455 | 2007-03-01 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EAST MISSISSIPPI STATE HOSPITAL.
| 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.