MALLORY COMMUNITY HEALTH (NPI# 1508312992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508312992 |
| Entity Type | Organization |
| Organization Name | MALLORY COMMUNITY HEALTH |
| Other Organization Name | MALLORY CHC SCHOOL BASED CLINIC - WILLIAM DEAN |
| Practice Address |
17280 Highway 17 Lexington MS 39095-6614 |
| Mailing Address |
Po Box 479 Lexington MS 39095-0479 |
| Practice Telephone | 6628341857 |
| Practice Fax Number | 6628341859 |
| Mailing Telephone | 6628341857 |
| Mailing Fax Number | 6628341859 |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2020-07-20 |
| Authorized Official Name | DR. CLYDE ROZELL CHAPMAN II (CHIEF EXEXCUTIVE OFFICER) |
| Authorized Official Telephone | 6628341857 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mallory CHC School Based Clinic - William Dean | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104348606 | Mallory Community Health | Clinic/Center | 9479 Brozville Rd, Lexington, MS 39095-7090 | 2017-07-17 |
| 1295282358 | Mallory Community Health | Clinic/Center | 9749 Brozville Road, Lexington, MS 39095 | 2016-09-07 |
| 1477009876 | Mallory Community Health | Clinic/Center | 14494 Highway 51, Durant, MS 39063-9627 | 2016-08-27 |
| 1427504943 | Mallory Community Health | Clinic/Center | 12572 Highway 12, Lexington, MS 39095-8036 | 2016-08-26 |
| 1104279355 | Mallory Community Health | Clinic/Center | 3877 Highway 51, Goodman, MS 39079-9588 | 2016-07-22 |
| 1740624881 | Mallory Community Health | Clinic/Center | 300 Yazoo Street, Lexington, MS 39095 | 2013-04-19 |
| 1053649749 | Mallory Community Health | Clinic/Center | 201 East Washington Street, Greenwood, MS 38930 | 2009-11-18 |
| 1053439133 | Mallory Community Health | Clinic/Center | 201a Magnolia St, Vaiden, MS 39176-5644 | 2007-03-27 |
| 1881713519 | Mallory Community Health | Clinic/Center | 9715 Highway 12 W, Tchula, MS 39169 | 2007-03-27 |
| 1902923527 | Mallory Community Health | Clinic/Center | 33795 Highway 12 East, Durant, MS 39063 | 2007-03-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MALLORY COMMUNITY HEALTH CENTER | 17280 Highway 17 South, Lexington, MS 39095-6614 |
| Street Address |
17280 HIGHWAY 17 |
| City | LEXINGTON |
| State | MS |
| Zip Code | 39095-6614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851548135 | Nadean Randle | Social Worker | 17280 Highway 17, Lexington, MS 39095-6614 | 2008-08-19 |
| 1093226763 | Kathryn Conner Carroll | Nurse Practitioner | 17280 Highway 17, Lexington, MS 39095-6614 | 2017-10-20 |
| 1558872663 | Sharon Mcmillin | Nurse Practitioner | 17280 Highway 17, Lexington, MS 39095-6614 | 2017-10-16 |
| 1639608813 | Leondrea Deanna Collins | Nurse Practitioner | 17280 Highway 17, Lexington, MS 39095-6614 | 2017-06-09 |
| 1033643432 | Melissa White | Nurse Practitioner | 17280 Highway 17, Lexington, MS 39095-6614 | 2017-04-12 |
| 1437490109 | Mallory Community Health Center | Clinic/Center | 17280 Highway 17, Lexington, MS 39095-6614 | 2013-03-06 |
| 1952630089 | Clyde Rozell Chapman II | Pediatrics | 17280 Highway 17, Lexington, MS 39095-6614 | 2009-12-20 |
| 1396987376 | Kyskie Bolton | Dietitian, Registered | 17280 Highway 17, Lexington, MS 39095-6614 | 2009-04-06 |
| 1710127782 | Lindsay Taylor | Dietitian, Registered | 17280 Highway 17, Lexington, MS 39095-6614 | 2009-03-03 |
| 1831341734 | Angelee B Mayo | Dietitian, Registered | 17280 Highway 17, Lexington, MS 39095-6614 | 2008-10-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295282358 | Mallory Community Health | Clinic/Center | 9749 Brozville Road, Lexington, MS 39095 | 2016-09-07 |
| 1336596170 | Telehealthone, LLC | Nurse Practitioner | 301 Yazoo Street, Lexington, MS 39095 | 2016-05-23 |
| 1740624881 | Mallory Community Health | Clinic/Center | 300 Yazoo Street, Lexington, MS 39095 | 2013-04-19 |
| 1912245671 | Ciera N Draine | Social Worker | Dr Arenia C Mallory Community Health Center, 17280 Highway 17 S, Lexington, MS 39095 | 2013-01-30 |
| 1184933384 | John D. Whitehead | Durable Medical Equipment & Medical Supplies | 22743 Hwy 12, Lexington, MS 39095 | 2010-10-05 |
| 1942536552 | Durant Primary Care Clinic | Clinic/Center | 22741 Bowling Green Rd, Lexington, MS 39095 | 2009-11-02 |
| 1205082963 | Heather Killebrew Tutor, Dmd, Pa | Dentist | 302 Court Square, Lexington, MS 39095 | 2008-08-13 |
| 1023145430 | Charles D Howard | Dentist | 102 Wall St, Lexington, MS 39095 | 2007-02-27 |
| 1619069622 | Charles Walton Campbell | Family Medicine | 102 Carrollton St, Lexington, MS 39095 | 2006-09-28 |
| 1972617876 | Lexington Primary Care | Clinic/Center | 110 Tchula Street, Lexington Primary Care, Lexington, MS 39095 | 2006-08-18 |
| Find all providers in zip 39095 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295356731 | Health Care Coalition of Lafayette County | Clinic/Center | 811 S Business Highway 13, Lexington, MO 64067-1515 | 2020-05-06 |
| 1104348606 | Mallory Community Health | Clinic/Center | 9479 Brozville Rd, Lexington, MS 39095-7090 | 2017-07-17 |
| 1295282358 | Mallory Community Health | Clinic/Center | 9749 Brozville Road, Lexington, MS 39095 | 2016-09-07 |
| 1427504943 | Mallory Community Health | Clinic/Center | 12572 Highway 12, Lexington, MS 39095-8036 | 2016-08-26 |
| 1982002549 | Samuel U. Rodgers Health Center, Inc | Clinic/Center | 2309 Aull Ln, Lexington, MO 64067 | 2014-12-15 |
| 1740624881 | Mallory Community Health | Clinic/Center | 300 Yazoo Street, Lexington, MS 39095 | 2013-04-19 |
| 1831386192 | Eastern Kentucky University | Clinic/Center | 151 N Eagle Creek, Suite 220, Lexington, KY 40509-1892 | 2007-10-01 |
| 1164614053 | Samuel U. Rodgers Health Center, Inc. | Clinic/Center | 811 S Business Highway 13 Ste A, Lexington, MO 64067 | 2007-08-14 |
| 1164460051 | Eastern Kentucky University | Clinic/Center | 1306 Versailles Rd, Suite 120, Lexington, KY 40504-1117 | 2006-06-03 |
| 1053951756 | Gaston Family Health Services, Inc | Clinic/Center | 32 Kirkwood Ave, Lexington, NC 27292-4024 | 2020-01-10 |
| Find all providers in LEXINGTON | ||||
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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.