1356427843 NPI number — SIMPSON COMMUNITY HEALTHCARE, INC

Table of content: (NPI 1356427843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356427843 NPI number — SIMPSON COMMUNITY HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMPSON COMMUNITY HEALTHCARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARRISVILLE MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356427843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1842 SIMPSON HWY 149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENDENHALL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39114-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-847-7136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1865 SIMPSON HIGHWAY 469
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39073-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-847-7744
Provider Business Practice Location Address Fax Number:
601-847-7122
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEDGEWORTH
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF FINANCIAL OFFICIER
Authorized Official Telephone Number:
601-847-7136

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07472704 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com