ELLISVILLE STATE SCHOOL (NPI# 1568468080) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568468080 |
| Entity Type | Organization |
| Organization Name | ELLISVILLE STATE SCHOOL |
| Practice Address |
1101 Hwy 11 S Ellisville MS 39437-4444 |
| Practice Telephone | 6014779384 |
| Practice Fax Number | 6014775700 |
| Mailing Telephone | 6014779384 |
| Mailing Fax Number | 6014775700 |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. SUZIE LASSITER (DIRECTOR) |
| Authorized Official Telephone | 6014779384 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | C00638 | MS | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285947408 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2010-07-16 |
| 1811135718 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-01-30 |
| 1164582821 | Ellisville State School | Technician | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-12-11 |
| 1578668901 | Ellisville State School | Pharmacy | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-13 |
| 1720181191 | Ellisville State School | Health Maintenance Organization | 1101 Highway 11 S, Ellisville, MS 39437-4443 | 2006-09-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ELLISVILLE STATE SCHOOL | 1101 Highway 11 S Eville, Ellisville, MS 39437-4443 |
| Street Address |
1101 HWY 11 S |
| City | ELLISVILLE |
| State | MS |
| Zip Code | 39437-4444 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285947408 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2010-07-16 |
| 1003055005 | Stephanie D. Smith | Nurse Practitioner | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-02-13 |
| 1811135718 | Ellisville State School | Intermediate Care Facility, Mentally Retarded | 1101 Hwy 11 S, Ellisville, MS 39437-4443 | 2009-01-30 |
| 1194743138 | Rushikesh H. Mehta | Pediatrics | 1101 Hwy 11 S, Ellisville State School, Ellisville, MS 39437-4443 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227759 | Courtney J. Sims | Nurse Practitioner | 80 Hal Crocker Road, Ellisville, MS 39437 | 2020-02-19 |
| 1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
| 1972851814 | Dental Group of Ellisville, Pllc | Dentist | 97 Hal Crocker Road, Ellisville, MS 39437 | 2012-08-27 |
| 1891920518 | Amy E Young | Speech-Language Pathologist | 471 Hwy 590, Ellisville, MS 39437 | 2009-05-26 |
| 1053486852 | Natalia Angelia Stevenson | Nurse Practitioner | Ellisville State School, 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-11-21 |
| 1831275189 | Womens Pavilion of South Mississippi, Pllc | Obstetrics & Gynecology | 1242 Hwy 29 North, Ellisville, MS 39437 | 2006-10-30 |
| 1861578635 | Jennifer Reeder Mascagni | Nurse Practitioner | 1203 Ave B Ste 200, Ellisville, MS 39437 | 2006-10-27 |
| 1851499982 | Kathleen Frances Mccoy | Physical Therapist | 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-09-20 |
| 1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
| 1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
| Find all providers in zip 39437 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508030008 | Sheahan Eagan Family Care LLC | Clinic/Center | 16021 Manchester Rd, Ellisville, MO 63011-2103 | 2008-04-15 |
| 1851564017 | Shaffer Eye Clinic | Clinic/Center | 5203 Highway 11 N, Ellisville, MS 39437-5001 | 2008-04-09 |
| 1104014521 | Family Wellness Chiropractic, Lcc | Clinic/Center | 355 Ozark Trail Dr Ste 9, Clayton-clarkson Center, Ellisville, MO 63011-2164 | 2007-10-10 |
| 1699131573 | Legacy Healthcare Services | Clinic/Center | 15822 Clayton Rd, Ellisville, MO 63011-2212 | 2016-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760080337 | Traditions Hospice of Biloxi, LLC | Clinic/Center | 243 Beauvoir Rd Ste B, Biloxi, MS 39531-4008 | 2020-10-15 |
| 1386242097 | Traditions Hospice of Ridgeland, LLC | Clinic/Center | 680 Highway 51 Ste L, Ridgeland, MS 39157-2103 | 2020-10-14 |
| 1346848694 | Hayco LLC | Clinic/Center | 425 S Jackson St, Brookhaven, MS 39601-3817 | 2020-10-09 |
| 1023620135 | Neshoba County General Hospital-nursing Home | Clinic/Center | 406 Stribling St, Philadelphia, MS 39350-3344 | 2020-08-19 |
| 1023628245 | Durrett Health Care LLC | Clinic/Center | 1515 Munsford Dr, New Albany, MS 38652-7407 | 2020-08-03 |
| 1124644968 | First Choice Family Medical Clinic, LLC | Clinic/Center | 50 Highway 388, Brooksville, MS 39739 | 2020-06-17 |
| 1104447507 | Grace & Mercy Healthcare Center | Clinic/Center | 131 Lexington St, Pickens, MS 39146-3914 | 2020-04-27 |
| 1437788908 | Wellness Center | Clinic/Center | 1727 6th St, Meridian, MS 39301-5249 | 2020-04-06 |
| 1669018008 | Maximum Care After Hours Clinic, LLC | Clinic/Center | 212 Highway 61, Shaw, MS 38773-3877 | 2019-11-20 |
| 1598316895 | Florence Health Complex, LLC | Clinic/Center | 130 S Church St, Florence, MS 39073-8478 | 2019-09-27 |
| Find all providers with the same taxonomy | ||||
| City | ELLISVILLE |
| Zip Code | 39437 |
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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.