| East Mississippi State Hospital | |
|
4555 Highland Park Drive Meridian MS 39307-2903 | |
| (601) 581-7562 | |
| (601) 581-7676 |
| Full Name | East Mississippi State Hospital |
|---|---|
| Speciality | Clinic/Center |
| Location | 4555 Highland Park Drive, Meridian, Mississippi |
| Authorized Official Name and Position | William Hamrick Entrekin (BUSINESS SERVICES DIRECTOR) |
| Authorized Official Contact | 6015817969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Mississippi State Hospital P.o. Box 4128 West Station Meridian MS 39304-4128 Ph: (601) 581-7562 | East Mississippi State Hospital 4555 Highland Park Drive Meridian MS 39307-2903 Ph: (601) 581-7562 |
| NPI Number | 1972689313 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 07/27/2020 |
| Medicare PECOS PAC ID | 3476440900 |
|---|---|
| Medicare Enrollment ID | O20040301000734 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972689313 | NPI | - | NPPES |
| 00023122 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 313M00000X | Nursing Facility/intermediate Care Facility | 1230 (Mississippi) | Secondary |
| Provider Name | Perry Wallace |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922044502 PECOS PAC ID: 4981516432 Enrollment ID: I20040526000946 |
| Provider Name | Rebecca S Blount |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992859946 PECOS PAC ID: 8628970373 Enrollment ID: I20050701000490 |
| Provider Name | Rolando Abangan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417930884 PECOS PAC ID: 0042112336 Enrollment ID: I20050817000137 |
| Provider Name | Rolanda T Pace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386703171 PECOS PAC ID: 8527164326 Enrollment ID: I20070510000160 |
| Provider Name | Janet D Pugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114085776 PECOS PAC ID: 1850491804 Enrollment ID: I20070705000439 |
| Provider Name | Stephen A Tramill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518940964 PECOS PAC ID: 0648362079 Enrollment ID: I20070815000412 |
| Provider Name | Linda F Mccullar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083791461 PECOS PAC ID: 4385703594 Enrollment ID: I20081105000499 |
| Provider Name | Bridget M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902139322 PECOS PAC ID: 6901090075 Enrollment ID: I20101102001303 |
| Provider Name | Roshundia L Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700190592 PECOS PAC ID: 6305030420 Enrollment ID: I20101103000329 |
| Provider Name | Tina D Clearman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700142403 PECOS PAC ID: 4789846676 Enrollment ID: I20120511000025 |
| Provider Name | Brenda Lee Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306105705 PECOS PAC ID: 9537325980 Enrollment ID: I20120730000473 |
| Provider Name | Courtney Anita Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336486422 PECOS PAC ID: 5496997371 Enrollment ID: I20130805000842 |
| Provider Name | Kim Elliot Nagel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235373663 PECOS PAC ID: 2567357247 Enrollment ID: I20130828000718 |
| Provider Name | Daniel Munn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417356304 PECOS PAC ID: 1557686649 Enrollment ID: I20150212001012 |
| Provider Name | Jennifer Alisha Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356995682 PECOS PAC ID: 9638596232 Enrollment ID: I20200827002043 |
| Provider Name | Kristan S Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043988496 PECOS PAC ID: 1951799279 Enrollment ID: I20230817002928 |
| Provider Name | Amber Lowery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558049767 PECOS PAC ID: 4688013279 Enrollment ID: I20240416000825 |
Greater Meridian Health Clinic, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2701 Davis St, Meridian, MS 39301 Phone: 601-693-0118 Fax: 844-778-8922 | |
Magnolia Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4555 Highland Park Dr, Meridian, MS 39307 Phone: 601-481-1135 Fax: 601-581-7676 | |
Laird Hospital, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1500 Highway 19 N, Meridian, MS 39307 Phone: 601-483-5353 Fax: 601-696-3231 | |
Greater Meridian Health Clinic, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2701 Davis St, Meridian, MS 39301 Phone: 601-693-0118 Fax: 844-778-8922 | |
Anderson Physician Alliance, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 20th St, Meridian, MS 39301 Phone: 601-553-6361 Fax: 601-484-5384 | |
Zodiac Medical Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 627 64th Ave, Meridian, MS 39307 Phone: 470-633-1970 Fax: 404-738-1614 | |
Primary Medical Services Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5000 Highway 39 N, Meridian, MS 39301 Phone: 601-646-0898 |