ELLISVILLE MEDICAL CLINIC – NPI #1942554761
Family Medicine

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

ELLISVILLE MEDICAL CLINIC is a provider located in ELLISVILLE, MS. NPPES has assigned the NPI number 1942554761 to ELLISVILLE MEDICAL CLINIC on October 31, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “ELLISVILLE MEDICAL CLINIC” is a dba name, the actual legal business name for this organization is SOUTH CENTRAL REGIONAL MEDICAL CENTER. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207Q00000X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ELLISVILLE MEDICAL CLINIC below.

NPI Profile for
SOUTH CENTRAL REGIONAL MEDICAL CENTER

NPI Number
1942554761
Enumeration Date

(more than 13 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing Business As (dba): ELLISVILLE MEDICAL CLINIC
Primary location
1203 AVENUE B
ELLISVILLE, MS 39437-2080
Phone: (601) 477-8553 Fax: (601) 477-9158
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
JAMES CANIZARO
C.F.O. / VICE PRESIDENT
Phone: (601) 399-6139
Updated
Identifiers

Identifiers for ELLISVILLE MEDICAL CLINIC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMS09014135
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207Q00000X
- Family Medicine (Primary)
2080A0000X
- Pediatrics / Adolescent Medicine
207V00000X
- Obstetrics & Gynecology

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.