SOUTH CENTRAL REGIONAL MEDICAL CENTER (NPI# 1942554761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942554761 |
| Entity Type | Organization |
| Organization Name | SOUTH CENTRAL REGIONAL MEDICAL CENTER |
| Other Organization Name | ELLISVILLE MEDICAL CLINIC |
| Practice Address |
1203 Avenue B Ellisville MS 39437-2080 |
| Practice Telephone | 6014778553 |
| Practice Fax Number | 6014779158 |
| Mailing Telephone | 6014778553 |
| Mailing Fax Number | 6014779158 |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2012-10-31 |
| Authorized Official Name | MR. JAMES T CANIZARO (C.F.O. / VICE PRESIDENT) |
| Authorized Official Telephone | 6013996139 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09014135 | 05 |
| Other Name | Type Code |
|---|---|
| Ellisville Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1730121088 | South Central Regional Medical Center | Nursing Facility/Intermediate Care Facility | 1100 West Dr, Laurel, MS 39440-4730 | 2006-06-12 |
| 1437199213 | South Central Regional Medical Center | Skilled Nursing Facility | 683 County Home Rd, Ellisville, MS 39437-8455 | 2006-06-08 |
| 1609813757 | South Central Regional Medical Center | Obstetrics & Gynecology | 203 S 12th Ave, Laurel, MS 39440-4324 | 2006-05-31 |
| 1629058094 | South Central Regional Medical Center | Ambulance | 23 Mason St, Laurel, MS 39440-4437 | 2006-01-20 |
| 1093790404 | South Central Regional Medical Center | Home Health | 2260 Us Highway 15 North, Laurel, MS 39440-1521 | 2005-12-08 |
| 1114923059 | South Central Regional Medical Center | Skilled Nursing Facility | 305 E Ivy St, Ellisville, MS 39437-2746 | 2005-06-24 |
| 1619973542 | South Central Regional Medical Center | General Acute Care Hospital | 1220 Jefferson St, Laurel, MS 39440-4355 | 2005-06-24 |
| 1134762610 | South Central Regional Medical Center | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2019-10-28 |
| 1114353539 | South Central Regional Medical Center | Dermatology | 920 Matthew Dr, Suite 8, Waynesboro, MS 39367-2553 | 2013-09-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTH CENTRAL REGIONAL MEDICAL CENTER, INC | 1220 Jefferson St, Laurel, MS 39440-4355 |
| Street Address |
1203 AVENUE B |
| City | ELLISVILLE |
| State | MS |
| Zip Code | 39437-2080 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
| 1801226287 | South Central Clinics, Inc | Family Medicine | 1203 Avenue B, Ellisville, MS 39437-2080 | 2013-11-20 |
| 1528498532 | South Central Clinics, Inc. | Obstetrics & Gynecology | 1203 Avenue B, Suite 300, Ellisville, MS 39437-2080 | 2013-11-13 |
| 1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
| 1740226018 | Vicki Hampton | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437-2080 | 2006-06-22 |
| 1811936016 | Michael Casey | Family Medicine | 1203 Avenue B, Ellisville, MS 39437-2080 | 2006-06-05 |
| 1669446001 | Benjamin Michael Weber | Obstetrics & Gynecology | 1203 Avenue B, Ste 300, Ellisville, MS 39437-2080 | 2006-02-14 |
| 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 |
| 1316980097 | Donald Scoggin | Nurse Practitioner | 1203 Ave B, Ellisville, MS 39437 | 2006-06-13 |
| 1427098003 | South Central Clinics, Inc. | Clinic/Center | 1203 Ave B, Suite 200, Ellisville, MS 39437 | 2006-06-08 |
| Find all providers in zip 39437 | ||||
| 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 |
|---|---|---|---|---|
| 1407151129 | Glenn Edward Hogancamp | Family Medicine | 35 Quail Ave., Ellisville, MO 63021 | 2011-01-12 |
| 1477561728 | Joseph R Danford | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2006-08-03 |
| 1417974080 | Jessee Crane | Family Medicine | 233 Clarkson Rd, Ellisville, MO 63011-2219 | 2006-07-17 |
| 1518378116 | William Currie | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2014-05-16 |
| 1801226287 | South Central Clinics, Inc | Family Medicine | 1203 Avenue B, Ellisville, MS 39437-2080 | 2013-11-20 |
| 1881930469 | South Ridge Family Clinic, LLC | Family Medicine | 80 Hal Crocker Rd, Ellisville, MS 39437-2089 | 2012-12-31 |
| 1477748648 | Shannon L Goldsmith | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2007-09-11 |
| 1275735458 | Cynthia J Poelker | Family Medicine | 225 Clarkson Rd, Ellisville, MO 63011-2278 | 2007-06-01 |
| 1952513541 | Clarissa Jara Allen | Family Medicine | 225 Clarkson Rd, Ellisville, MO 63011-2278 | 2007-05-04 |
| 1457451775 | Hattiesburg Clinic Pa | Family Medicine | 822 Main St, Ellisville, MS 39437-2425 | 2006-09-25 |
| Find all providers in ELLISVILLE | ||||
| City | ELLISVILLE |
| Zip Code | 39437 |
Please comment or provide details below to improve the information on SOUTH CENTRAL REGIONAL MEDICAL CENTER.
| 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.