JEFFERSON COUNTY HOSPITAL (NPI# 1780894253) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780894253 |
| Entity Type | Organization |
| Organization Name | JEFFERSON COUNTY HOSPITAL |
| Other Organization Name | JEFFERSON COUNTY HOSPITAL ER PHYSICIAN CLAIMS |
| Practice Address |
870 Main Street Fayette MS 39069 |
| Practice Telephone | 6017863401 |
| Practice Fax Number | 6017863400 |
| Mailing Telephone | 6017863401 |
| Mailing Fax Number | 6017863400 |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JERRY KENNEDY (ADMINISTRATOR) |
| Authorized Official Telephone | 6017863401 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207Q00000X | Family Medicine | 14997 | MS | Allopathic & Osteopathic Physicians |
| X | 207Q00000X | Family Medicine | 07965 | MS | Allopathic & Osteopathic Physicians |
| X | 207R00000X | Internal Medicine | 16670 | MS | Allopathic & Osteopathic Physicians |
| X | 207RH0002X |
Internal Medicine Specialization: Hospice and Palliative Medicine |
14721 | MS | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Jefferson County Hospital ER Physician Claims | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881294536 | Jefferson County Hospital | Clinic/Center | 107 W Harrison St, Richland, IA 52585-9549 | 2020-10-30 |
| 1225247505 | Jefferson County Hospital | Family Medicine | 870 Main Street, Fayette, MS 39069 | 2007-05-22 |
| 1871690289 | Jefferson County Hospital | Nursing Facility/Intermediate Care Facility | 400 Highland St, Fairfield, IA 52556-3713 | 2006-09-20 |
| 1043204555 | Jefferson County Hospital | General Acute Care Hospital | 870 South Main Street, Fayette, MS 39069-0577 | 2005-09-12 |
| 1386018083 | Jefferson County Hospital | Psychiatric Unit | 870 Main St, Fayette, MS 39069-5695 | 2015-11-18 |
| 1457728008 | Jefferson County Hospital | Clinic/Center | 2000b S Main St, Fairfield, IA 52556-9572 | 2015-08-31 |
| 1245643972 | Jefferson County Hospital | Family Medicine | 2000 S Main St, Fairfield, IA 52556-9572 | 2014-06-10 |
| 1487944856 | Jefferson County Hospital | Pharmacy | 2000 S Main St, Fairfield, IA 52556-9572 | 2011-04-19 |
| 1972771384 | Jefferson County Hospital | Internal Medicine | 2000 S Main St, Fairfield, IA 52556-9572 | 2008-02-19 |
| 1407071913 | Jefferson County Hospital | Personal Emergency Response Attendant | 2000 S Main St, Fairfield, IA 52556-9572 | 2007-04-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | JEFFERSON COUNTY HOSPITAL | 870 Main St, Fayette, MS 39069-5695 |
| Street Address |
870 MAIN STREET |
| City | FAYETTE |
| State | MS |
| Zip Code | 39069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225247505 | Jefferson County Hospital | Family Medicine | 870 Main Street, Fayette, MS 39069 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265063135 | Georgene Ferrie | Massage Therapist | 1612 Main St., Fayette, MS 39069 | 2020-01-30 |
| 1942741764 | Prime Health and Wellness | Nurse Practitioner | 300 Shannon Street, Fayette, MS 39069 | 2017-03-13 |
| 1063967768 | P-cares Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 3476 River Road, Box 1055, Fayette, MS 39069 | 2016-08-23 |
| 1669866331 | Kanayo Ugboaja | Contractor | 157 Hicks St, Fayette, MS 39069 | 2015-03-20 |
| 1053666503 | Valerie Michele White | Nurse Practitioner | 225 Community Dr., Fayette, MS 39069 | 2012-07-20 |
| 1265752356 | John Ellis Evans | Family Medicine | 456 River Road, Fayette, MS 39069 | 2010-06-11 |
| 1922271691 | Jefferson Comprehensive Health Center Inc | Clinic/Center | Route 1 Box 266, Fayette, MS 39069 | 2008-04-02 |
| 1356410229 | Johnny B Bills | Family Medicine | 225 Community Ave, Fayette, MS 39069 | 2006-11-07 |
| 1962583971 | Priscilla Jackson | Nurse Practitioner | 225 Community Drive, Fayette, MS 39069 | 2006-10-17 |
| 1174627459 | Anazia Medical II, Inc. | Internal Medicine | 1264 Main Street, Suite A, Fayette, MS 39069 | 2006-09-08 |
| Find all providers in zip 39069 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265752356 | John Ellis Evans | Family Medicine | 456 River Road, Fayette, MS 39069 | 2010-06-11 |
| 1225247505 | Jefferson County Hospital | Family Medicine | 870 Main Street, Fayette, MS 39069 | 2007-05-22 |
| 1356410229 | Johnny B Bills | Family Medicine | 225 Community Ave, Fayette, MS 39069 | 2006-11-07 |
| 1053420323 | Jon E. Sanford,m.d.,p.c. | Family Medicine | 122 17th Ct Ne, Fayette, AL 35555-1353 | 2006-08-30 |
| 1912011370 | Janice L Hudson | Family Medicine | 1031 Temple Ave N, Fayette, AL 35555-1923 | 2006-08-19 |
| 1346289105 | Charles W Nolen Jr. | Family Medicine | 1705 1st Way Nw, Fayette, AL 35555-1307 | 2006-06-06 |
| 1578557948 | Garry W Magouirk | Family Medicine | 110 23rd St Nw, Fayette, AL 35555-1001 | 2005-08-31 |
| 1306462775 | Andrew Bennett Wright | Family Medicine | 308 S Church St, Fayette, MO 65248-1243 | 2020-06-22 |
| 1780200113 | Hannah Braungardt | Family Medicine | 308 S Church St, Fayette, MO 65248-1243 | 2020-06-22 |
| 1861018210 | Dalton Lohsandt | Family Medicine | 308 S Church St, Fayette, MO 65248-1243 | 2020-06-22 |
| Find all providers in FAYETTE | ||||
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| 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.