REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE (NPI# 1861645657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861645657 |
| Entity Type | Organization |
| Organization Name | REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE |
| Other Organization Name | PINE BELT MENTAL HEALTHCARE RESOURCES |
| Practice Address |
103 S 19th Ave Hattiesburg MS 39401-6171 |
| Practice Telephone | 6015444641 |
| Practice Fax Number | 6014504632 |
| Mailing Telephone | 6015444641 |
| Mailing Fax Number | 6014504632 |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2017-02-16 |
| Authorized Official Name | JERRY MAYO (CEO) |
| Authorized Official Telephone | 6015444641 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
07864/5.1 | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2117558 | 01 |
| Other Name | Type Code |
|---|---|
| Pine Belt Mental Healthcare Resources | Doing Business As Name - Organization |
| Street Address |
103 S 19TH AVE |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-6171 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982610572 | Region 12 Commission On Mental Health & Retardation Pine Belt Men | Clinic/Center | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2006-08-01 |
| 1780199935 | Christine Boehmer | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-12-11 |
| 1679084024 | Donald Allan Dearman | Nurse Practitioner | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-10-12 |
| 1750808176 | Jason Courtney | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-08-25 |
| 1780101105 | Raymond Wooten | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-08-25 |
| 1073039830 | Jessica Owens | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-08-14 |
| 1275057457 | Shalaunda Brown | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-07-31 |
| 1144744327 | Chyra Dixon | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-07-31 |
| 1376066910 | Pamela Griffith | Counselor | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-07-25 |
| 1912420720 | Katelin Holmes | Social Worker | 103 S 19th Ave, Hattiesburg, MS 39401-6171 | 2017-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295169753 | 30a Innovations,llc | Pharmacy | 3902 Hardy St, Hattiesburg, MS 39402-1541 | 2013-09-02 |
| 1174803993 | Auxilium Specialty Apothecary Pharmacy Inc | Pharmacy | 16 Keystone Dr Ste B, Hattiesburg, MS 39402-6121 | 2011-08-24 |
| 1598913972 | Advantage Medical Infusion LLC | Pharmacy | 5296 Old Highway 11, Suite 4, Hattiesburg, MS 39402-8380 | 2008-08-28 |
| 1790820645 | Newpointe Pharmacy | Pharmacy | 6555 U S Highway 98, Suite 6, Hattiesburg, MS 39402-8699 | 2007-02-20 |
| 1508965815 | Mississippi Cvs Pharmacy, L.L.C. | Pharmacy | 3910 Hardy St, Hattiesburg, MS 39402-1500 | 2006-09-22 |
| 1760409585 | Village Pharmacy, L.L.C. | Pharmacy | 560 Weathersby Rd, Suite 170, Hattiesburg, MS 39402-1164 | 2006-07-16 |
| 1548674658 | Southern Bone & Joint Specialists | Pharmacy | 3688 Veterans Memorial Dr Ste 200, Hattiesburg, MS 39401 | 2014-06-17 |
| 1144383613 | Pomank Ventures LLC | Pharmacy | 500 Katie Ave, Hattiesburg, MS 39401-4380 | 2006-12-18 |
| 1992800502 | Freds Stores of Tennessee Inc | Pharmacy | 5266 Old Highway 11, Suite 160, Hattiesburg, MS 39402-7817 | 2006-09-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164038485 | Quinn's Family Pharmacy of Newton | Pharmacy | 193 Northside Dr, Newton, MS 39345-9523 | 2020-09-22 |
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1649883844 | Natchez Wellness Pharmacy | Pharmacy | 29 Sergeant Prentiss Dr Ste 5, Natchez, MS 39120-4743 | 2020-08-26 |
| 1952910366 | Ct Stamps Inc | Pharmacy | 206 Marion Avenue, Mccomb, MS 39648 | 2020-07-31 |
| 1114566122 | Valley Drugs, Inc. | Pharmacy | 327b S Main St, Water Valley, MS 38965-3318 | 2019-12-23 |
| 1851939318 | Smith Pharmacy, Inc. | Pharmacy | 306 Northside Drive, Newton, MS 39345 | 2019-12-16 |
| 1285270801 | Proxsys Rx - Rush LLC | Pharmacy | 14916 Hwy 16 W, Unit #1, Dekalb, MS 39328 | 2019-11-19 |
| 1518501592 | Southwest Pharmacy Inc | Pharmacy | 3000 Plaza Dr Ste B, Tylertown, MS 39667-9227 | 2019-11-01 |
| 1669015210 | Hometown Family Pharmacy, Inc. | Pharmacy | 930 Hall St Ste H, Wiggins, MS 39577-2113 | 2019-10-25 |
| 1225671001 | A & A Infusion & Specialty, LLC | Pharmacy | 124 E Jackson St, Belzoni, MS 39038-3642 | 2019-10-23 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
Please comment or provide details below to improve the information on REGION 12 COMMISSION ON MENTAL HEALTH & RETARDATION PINE.
| 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.