NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION (NPI# 1679903546) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679903546 |
| Entity Type | Organization |
| Organization Name | NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION |
| Other Organization Name | LIFECORE HEALTH GROUP |
| Practice Address |
499 Gloster Creek Vlg Suite A-3 Tupelo MS 38801-4600 |
| Mailing Address |
2434 S Eason Blvd Tupelo MS 38804-6942 |
| Practice Telephone | 6628441717 |
| Practice Fax Number | 6626806416 |
| Mailing Telephone | 6626404595 |
| Mailing Fax Number | 6626806416 |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2020-02-27 |
| Authorized Official Name | RITA BERTHAY (CEO) |
| Authorized Official Telephone | 6626404595 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 000 | 05 | |
| MS | BLUE CROSS | 0000 | 01 |
| MS | 0000000 | 05 |
| Other Name | Type Code |
|---|---|
| Lifecore Health Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427489517 | Northeast Mental Health-mental Retardation Commission | Pharmacy | 499 Gloster Creek Vlg Ste A3, Tupelo, MS 38801-4600 | 2013-11-27 |
| 1548413628 | Northeast Mental Health-mental Retardation Commission | Clinic/Center | 2434 S Eason Blvd, Tupelo, MS 38804-6942 | 2008-11-03 |
| Street Address |
499 GLOSTER CREEK VLG SUITE A-3 |
| City | TUPELO |
| State | MS |
| Zip Code | 38801-4600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407856958 | Clarance Stephen Farmer II | Urology | 499 Gloster Creek Vlg, Suite A1, Tupelo, MS 38801-4600 | 2005-07-27 |
| 1508219221 | Jacob Rowland | Physician Assistant | 499 Gloster Creek Vlg, Suite G1, Tupelo, MS 38801-4600 | 2016-07-18 |
| 1073960308 | Jordan Ward | Licensed Practical Nurse | 499 Gloster Creek Vlg, Tupelo, MS 38801-4600 | 2016-05-17 |
| 1326402660 | Stephanie Denton | Licensed Practical Nurse | 499 Gloster Creek Vlg, Suite A-3, Tupelo, MS 38801-4600 | 2016-04-13 |
| 1942606256 | Ivancic Pediatric Clinic Pa | Clinic/Center | 499 Gloster Creek Vlg, Suite H-3, Tupelo, MS 38801-4600 | 2014-11-13 |
| 1063848638 | Jennifer G. Estock | Nurse Practitioner | 499 Gloster Creek Vlg, Suite D-1, Tupelo, MS 38801-4600 | 2013-09-16 |
| 1508193459 | David Benson Sumerford | Nurse Practitioner | 499 Gloster Creek Vlg, Suite D-1, Tupelo, MS 38801-4600 | 2009-11-13 |
| 1114252160 | Katherine Mcduffie | Nurse Practitioner | 499 Gloster Creek Vlg, Suite A-2, Tupelo, MS 38801-4600 | 2009-10-08 |
| 1871736496 | John Russell, IIi, D.m.d. | Dentist | 499 Gloster Creek Vlg, Tupelo, MS 38801-4600 | 2009-04-13 |
| 1427206556 | Janet Richey | Nurse Practitioner | 499 Gloster Creek Vlg, Ste. A-2, Tupelo, MS 38801-4600 | 2008-09-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1003443458 | Nicole Sherice Taylor | Nurse Practitioner | 845 South Gloster Street, Tupelo, MS 38801 | 2020-03-25 |
| 1821556838 | Wilco Healthcare of North Mississippi, Pllc | Point of Service | 1514 Co Rd 41, Tupelo, MS 38801 | 2019-03-08 |
| 1821565235 | Stephanie K Cagle | Nurse Practitioner | 218 S Thomas St Ste 120-121, Tupelo, MS 38801 | 2018-10-24 |
| 1073092326 | Lauren Parrish | Nurse Practitioner | 1573 Medical Park Circle, Tupelo, MS 38801 | 2018-08-08 |
| 1467948687 | North Mississippi Medcial Center, Inc. | Nurse Practitioner | 990 S Madison St Ste 2, Tupelo, MS 38801 | 2018-07-11 |
| 1043700933 | Hooks Diabetes & Medicine Clinic | Non-Pharmacy Dispensing Site | 2610 Traceland Drive, Ste A, Tupelo, MS 38801 | 2018-05-16 |
| 1073035903 | Annette C Riddle | Counselor | 1004 Eisenhower Drive, Tupelo, MS 38801 | 2017-07-12 |
| 1548709678 | Jaime Summers | Nurse Practitioner | 2780 West Jackson St, Tupelo, MS 38801 | 2017-02-22 |
| 1073975611 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 1168 Cross Creek Drive, Tupelo, MS 38801 | 2016-03-23 |
| Find all providers in zip 38801 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649727447 | North Mississippi Medical Center Inc. | Clinic/Center | 1573 Medical Park Cir, Tupelo, MS 38801-6580 | 2016-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730786120 | Ochsner Medical Center - Hancock, LLC | Clinic/Center | 2274 Highway 43 S Ste 200, Picayune, MS 39466-8141 | 2020-10-08 |
| 1306460282 | Covington County Hospital | Clinic/Center | 105 Eaton St, Taylorsville, MS 39168-5614 | 2020-06-05 |
| 1871117747 | Covington County Hospital | Clinic/Center | 1039 Highway 42 Ste C, Sumrall, MS 39482-4478 | 2020-06-05 |
| 1194365338 | Bounds Family Medical | Clinic/Center | 870 Main St Ste A, Fayette, MS 39069-5695 | 2020-01-15 |
| 1720649577 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 19 Third St, Belmont, MS 38827 | 2019-06-24 |
| 1255999611 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 400 3rd Ave 32 West, New Houlka, MS 38850 | 2019-05-31 |
| 1598238545 | South Sunflower County Hospital | Clinic/Center | 1001 West Delta, Moorhead, MS 38761 | 2019-01-02 |
| 1790272185 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 670 Ms-178, Suite 5, Sherman, MS 38869 | 2018-04-20 |
| 1124515515 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 2200 5th St N, Columbus, MS 39705-2212 | 2018-04-20 |
| 1205323698 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 815 2nd Ave N, Columbus, MS 39701-4703 | 2018-04-20 |
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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.