Basic Information
Provider Information | |||||||||
NPI: | 1831393206 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SIMPSON COMMUNITY HEALTHCARE, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SIMPSON COMMUNITY HEALTHCARE, INC. EMERGENCY ROOM | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1842 SIMPSON HIGHWAY 149 | ||||||||
Address2: |   | ||||||||
City: | MENDENHALL | ||||||||
State: | MS | ||||||||
PostalCode: | 391143438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6018477130 | ||||||||
FaxNumber: | 6018477104 | ||||||||
Practice Location | |||||||||
Address1: | 1842 SIMPSON HIGHWAY 149 | ||||||||
Address2: |   | ||||||||
City: | MENDENHALL | ||||||||
State: | MS | ||||||||
PostalCode: | 391143438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6018477130 | ||||||||
FaxNumber: | 6018477104 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RILEY | ||||||||
AuthorizedOfficialFirstName: | SHELLY | ||||||||
AuthorizedOfficialMiddleName: | G | ||||||||
AuthorizedOfficialTitleorPosition: | CCO BUSINESS OFFICE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 6018477130 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 92114 | MS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
ID | Type | State | Issuer | Description | 9012493 | 05 | MS |   | MEDICAID | C00143 | 05 | MS |   | MEDICAID |