Basic Information
| Provider Information | |||||||||
| NPI: | 1609069962 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIMPSON COMMUNITY HEALTHCARE, INC | ||||||||
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| OtherOrganizationName: | SGH MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1842 SIMPSON HIGHWAY 149 | ||||||||
| Address2: | |||||||||
| City: | MENDENHALL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391143438 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1827C SIMPSON HIGHWAY 149 | ||||||||
| Address2: | |||||||||
| City: | MENDENHALL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391143439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018472221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | NEELY | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6018477214 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.