1831393206 NPI number — SIMPSON COMMUNITY HEALTHCARE, INC.

Table of content: MR. MUHAMMAD AHMAR SIDDIQUI M.D (NPI 1689824443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831393206 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:
SIMPSON COMMUNITY HEALTHCARE, INC. EMERGENCY ROOM
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:
1831393206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1842 SIMPSON HIGHWAY 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:
39114-3438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-847-7130
Provider Business Mailing Address Fax Number:
601-847-7104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1842 SIMPSON HIGHWAY 149
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDENHALL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39114-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-847-7130
Provider Business Practice Location Address Fax Number:
601-847-7104
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CCO BUSINESS OFFICE DIRECTOR
Authorized Official Telephone Number:
601-847-7130

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  92114 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9012493 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: C00143 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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