=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831393206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMPSON COMMUNITY HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1842 SIMPSON HIGHWAY 149
-----------------------------------------------------
City | MENDENHALL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39114-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-847-7130
-----------------------------------------------------
Fax | 601-847-7104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1842 SIMPSON HIGHWAY 149
-----------------------------------------------------
City | MENDENHALL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39114-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-847-7130
-----------------------------------------------------
Fax | 601-847-7104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CCO BUSINESS OFFICE DIRECTOR
-----------------------------------------------------
Name | SHELLY G RILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-847-7130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 92114
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------