GREATER MERIDIAN HEALTH CLINIC, INC. (NPI# 1962509208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962509208 |
| Entity Type | Organization |
| Organization Name | GREATER MERIDIAN HEALTH CLINIC, INC. |
| Other Organization Name | SCOOBA FAMILY MEDICAL CLINIC |
| Practice Address |
927 Kemper St Scooba MS 39358-7478 |
| Mailing Address |
2701 Davis St Meridian MS 39301-5708 |
| Practice Telephone | 6624769595 |
| Practice Fax Number | 6019650324 |
| Mailing Telephone | 6016930118 |
| Mailing Fax Number | 6019650324 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-03-26 |
| Authorized Official Name | WILBERT L. JONES (CEO) |
| Authorized Official Telephone | 6016930118 |
| Is Organization Subpart | Y |
| Parent Organization Name | GREATER MERIDIAN HEALTH CLINIC, INC. |
| 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 | 9015889 | 05 |
| Other Name | Type Code |
|---|---|
| Scooba Family Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689187155 | Greater Meridian Health Clinic, Inc. | Local Education Agency (LEA) | 4000 10th St, Meridian, MS 39307-5956 | 2017-11-07 |
| 1275046716 | Greater Meridian Health Clinic, Inc. | Local Education Agency (LEA) | 900 44th Ave, Meridian, MS 39307-5913 | 2017-11-07 |
| 1982701223 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 201 Birch St, De Kalb, MS 39328-8017 | 2006-09-20 |
| 1841397189 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 67 Mulberry Street, Shuqualak, MS 39361 | 2006-09-20 |
| 1770680019 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 14130 Highway 15 S Ste D, Louisville, MS 39339-6452 | 2006-09-20 |
| 1396842027 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 105 Felix Long St, Starkville, MS 39759-8608 | 2006-09-16 |
| 1366955817 | Greater Meridian Health Clinic, Inc. | Local Education Agency (LEA) | 2320 32nd St, Meridian, MS 39305-4657 | 2017-11-07 |
| 1912008749 | Greater Meridian Health Clinic, Inc. | Pharmacy | 2701 Davis St, Meridian, MS 39301-5708 | 2006-09-26 |
| 1821199654 | Greater Meridian Health Clinic, Inc. | Dentist | 2701 Davis St, Meridian, MS 39301-5708 | 2006-09-26 |
| 1649371477 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 2701 Davis St, Meridian, MS 39301-5708 | 2006-09-26 |
| Street Address |
927 KEMPER ST |
| City | SCOOBA |
| State | MS |
| Zip Code | 39358-7478 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023196821 | Elizabeth Mcmahan | Nurse Practitioner | 927 Kemper Street, Scooba, MS 39358 | 2006-11-01 |
| 1740645142 | Suzanne Hagar | Registered Nurse | 6022 Binnsville Rd, Scooba, MS 39358-7219 | 2015-12-30 |
| 1811329543 | Shannon Wilkins | Physical Therapist | 652 Piney Woods Rd, Scooba, MS 39358-7451 | 2013-08-05 |
| 1205319183 | Steven Bontrager | Specialist/Technologist | 1512 Kemper St, Scooba, MS 39358-7601 | 2018-09-07 |
| 1447802749 | Ryota Nakagi | Specialist/Technologist | 1512 Kemper St, Scooba, MS 39358-7601 | 2019-07-16 |
| 1043780836 | East Mississippi Community College | General Practice | 1512 Kemper St, Scooba, MS 39358-7601 | 2018-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205319183 | Steven Bontrager | Specialist/Technologist | 1512 Kemper St, Scooba, MS 39358-7601 | 2018-09-07 |
| 1740645142 | Suzanne Hagar | Registered Nurse | 6022 Binnsville Rd, Scooba, MS 39358-7219 | 2015-12-30 |
| 1811329543 | Shannon Wilkins | Physical Therapist | 652 Piney Woods Rd, Scooba, MS 39358-7451 | 2013-08-05 |
| 1023196821 | Elizabeth Mcmahan | Nurse Practitioner | 927 Kemper Street, Scooba, MS 39358 | 2006-11-01 |
| 1447802749 | Ryota Nakagi | Specialist/Technologist | 1512 Kemper St, Scooba, MS 39358-7601 | 2019-07-16 |
| 1043780836 | East Mississippi Community College | General Practice | 1512 Kemper St, Scooba, MS 39358-7601 | 2018-12-05 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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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.