MISSISSIPPI STATE HOSPITAL (NPI# 1134366867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134366867 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI STATE HOSPITAL |
| Other Organization Name | LIGHTHOUSE MEDICAL CLINIC |
| Practice Address |
350 Capers Ave Jackson MS 39203-2131 |
| Practice Telephone | 6013518000 |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2009-01-16 |
| Authorized Official Name | MR. JAMES G. CHASTAIN (DIRECTOR OF HOSPITAL) |
| Authorized Official Telephone | 6013518000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
DCS-MSH | MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Lighthouse Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598750135 | Mississippi State Hospital | Pharmacy | 3550 Highway 468 W, Whitfield, MS 39193 | 2005-09-20 |
| 1093994295 | Mississippi State Hospital | Substance Abuse Rehabilitation Facility | 3550 Highway 468 W, Whitfield, MS 39193-5529 | 2007-10-24 |
| 1467532903 | Mississippi State Hospital | Skilled Nursing Facility | 3550 Highway 468 W, Pearl, MS 39208-5529 | 2006-10-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MISSISSIPPI STATE HOSPITAL | 3550 State Hwy 468 W, Whitfield, MS 39193 |
| Street Address |
350 CAPERS AVE |
| City | JACKSON |
| State | MS |
| Zip Code | 39203-2131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235743162 | Shymeka Bolden | Home Health | 405 Dewitt Ave, Jackson, MS 39203 | 2020-09-08 |
| 1083027544 | Debra Williams | Counselor | 514 West Fortification Ave, Jackson, MS 39203 | 2014-06-03 |
| 1336224179 | Mississippi State Hospital At Whitfield | Community Based Residential Treatment Facility, Mental Illness | 350 Capers Avenue, Jackson, MS 39203 | 2006-10-26 |
| 1568628980 | Mall Services, LLC | Clinic/Center | 2050 Martin Luther King Jr Dr, Jackson, MS 39203-1030 | 2008-08-05 |
| 1710022959 | Jackson Public Schools Dba Galloway Clinic | Registered Nurse | 186 Idlewild St, Jackson, MS 39203-1219 | 2007-02-21 |
| 1457522260 | Jimmie C Robinson | Durable Medical Equipment & Medical Supplies | 605 W Fortification St, Jackson, MS 39203-1706 | 2008-03-19 |
| 1093277428 | Connections Counseling & Consulting LLC | Social Worker | 338 Oak St, Jackson, MS 39203-1810 | 2019-04-04 |
| 1033504816 | Niesha Lasha Gilmore | Occupational Therapist | 519 Scott St, Jackson, MS 39203-1825 | 2015-03-30 |
| 1255952453 | Innovative Hands of Therapy Services LLC | Occupational Therapist | 519 Scott St, Jackson, MS 39203-1825 | 2020-04-29 |
| 1588812341 | Deepti Amol Janorkar | Dentist | 275 Roseneath Ave, Jackson, MS 39203-2052 | 2008-09-05 |
| Find all providers in zip 39203 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871103127 | Lupine Mental Health and Integrative Psychiatry LLC | Clinic/Center | 125 E Pearl Ave Ste 207, Jackson, WY 83001-8599 | 2020-08-02 |
| 1750908182 | Horizon Connections | Clinic/Center | 1818 Crane Ridge Dr Ste 101, Jackson, MS 39216-4912 | 2020-07-01 |
| 1295211787 | Nicole Rue, Psy.d., LLC | Clinic/Center | 1115 Maple Way Ste D, Jackson, WY 83001-8567 | 2018-07-17 |
| 1881102408 | Ava Family Services, LLC | Clinic/Center | 1910 Lakeland Dr Ste C, Jackson, MS 39216 | 2018-01-17 |
| 1033628466 | Bhg Lii, LLC | Clinic/Center | 794 Mcdonough Rd Ste 104, Jackson, GA 30233-1572 | 2017-09-28 |
| 1356732317 | Golden Gold Child Learning Center | Clinic/Center | 1155 Jackson Blvd, Jackson, MS 39204-2733 | 2015-02-12 |
| 1194964049 | Beacon Behavioral Health-jackson | Clinic/Center | 5360 I 55 N, Jackson, MS 39211-4026 | 2009-02-17 |
| 1780852194 | Mcwillie Counseling & Diagnostic Services | Clinic/Center | 5202 Keele St Ste 1, Jackson, MS 39206-4355 | 2008-02-19 |
| 1689628190 | Catholic Charities of Jackson, Lenawee and Hillsdale Counties | Clinic/Center | 1522 Joy Ave, Jackson, MI 49203-1933 | 2006-05-20 |
| 1063466274 | Jackson-hillsdale Community Mental Health Board | Clinic/Center | 1200 N. West Avenue, Jackson, MI 49202 | 2006-05-20 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.