Basic Information
| Provider Information | |||||||||
| NPI: | 1902000375 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIMPSON COMMUNITY HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | SIMPSON COMMUNITY HEALTHCARE, INC. RADIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| 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 | ||||||||
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| AuthorizedOfficialLastName: | RILEY | ||||||||
| AuthorizedOfficialFirstName: | SHELLY | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CCO BUSINESS OFFICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6018477130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 9013247 | 05 | MS | MEDICAID |