MALLORY COMMUNITY HEALTH (NPI# 1881713519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881713519 |
| Entity Type | Organization |
| Organization Name | MALLORY COMMUNITY HEALTH |
| Other Organization Name | DR. ARENIA C. MALLORY COMMUNITY HEALTH CENTER, INC. |
| Practice Address |
9715 Highway 12 W Tchula MS 39169 |
| Mailing Address |
Po Box 479 Lexington MS 39095-0479 |
| Practice Telephone | 6622354731 |
| Practice Fax Number | 6622355255 |
| Mailing Telephone | 6628341857 |
| Mailing Fax Number | 6628344937 |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2016-07-21 |
| Authorized Official Name | MR. CLYDE ROZELL CHAPMAN II (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6628341857 |
| Authorized Official Credential | MD |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09015634 | 05 |
| Other Name | Type Code |
|---|---|
| Dr. Arenia C. Mallory Community Health Center, Inc. | Doing Business As Name - 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 |
| 1902923527 | Mallory Community Health | Clinic/Center | 33795 Highway 12 East, Durant, MS 39063 | 2007-03-26 |
| 1013034636 | Mallory Community Health | Clinic/Center | 276 Nissan Parkway, Building C, Suite 100, Canton, MS 39046 | 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 |
9715 HIGHWAY 12 W |
| City | TCHULA |
| State | MS |
| Zip Code | 39169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457842585 | Heaven Sent Foot Healthcare, Plcc | Nursing Care | 160 Cypress Street, Tchula, MS 39169 | 2018-05-24 |
| 1417208422 | Doris Alexander | Adult Companion | 978 Main Street, Tchula, MS 39169 | 2012-10-01 |
| 1205104387 | Dealice Nikita Young | Registered Nurse | 160 Cypress St, Tchula, MS 39169 | 2011-12-05 |
| 1992946263 | The Myers Foundation Christian Family Health Centers | Specialist | 15548 Hwy. 49 East, Suite A, Tchula, MS 39169 | 2009-03-17 |
| 1447434642 | Thomas Ross | Audiologist | 605 Poplar St, Tchula, MS 39169 | 2007-12-24 |
| 1306038567 | Thomas Ross | Audiologist | 605 Poplar St., Tchula, MS 39169 | 2007-08-13 |
| 1891829677 | Glenn Daniel Roberts | Pharmacist | 112 Mercer St, Tchula, MS 39169 | 2007-03-15 |
| 1013053842 | Gdr, Inc | Pharmacy | 112 Mercer Street, Tchula, MS 39169 | 2007-01-29 |
| 1821099482 | Rhonda Givens-boles | Nurse Practitioner | 110 Mercer Street, Tchula, MS 39169 | 2005-08-04 |
| 1487835567 | Candice Smith | Social Worker | 16067 M. L. K. Dr., Tchula, MS 39169-0518 | 2007-11-17 |
| Find all providers in zip 39169 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1992305445 | Coastal Family Health Center, Inc | Clinic/Center | 5500 Hurley Wade Rd, Moss Point, MS 39562-8548 | 2020-10-26 |
| 1841890399 | Coastal Family Health Center, Inc | Clinic/Center | 10700 Yellow Jacket Rd, Ocean Springs, MS 39564-8038 | 2020-10-26 |
| 1033755343 | Access Family Health Services, Inc. | Clinic/Center | 179 Mullen Ave, Nettleton, MS 38858-6033 | 2019-11-21 |
| 1285280180 | Delta Health Center, Inc | Clinic/Center | 506 Washington Avenue, Moorhead, MS 38761 | 2019-08-15 |
| 1265088421 | Delta Health Center, Inc | Clinic/Center | 400 South Blvd, Drew, MS 38737-3508 | 2019-08-14 |
| 1215583356 | Delta Health Center, Inc. | Clinic/Center | 302 College Ave, Indianola, MS 38751-2112 | 2019-08-14 |
| 1063068252 | Delta Health Center, Inc | Clinic/Center | 1101 Oak St, Inverness, MS 38753-8725 | 2019-08-13 |
| 1750937959 | Delta Health Center, Inc | Clinic/Center | 212 E Claiborne St, Sunflower, MS 38778-9640 | 2019-08-13 |
| 1750937108 | Delta Health Center, Inc | Clinic/Center | 410 L F Packer Dr, Ruleville, MS 38771-3604 | 2019-08-12 |
| Find all providers with the same taxonomy | ||||
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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.