Provider Demographics
NPI:1023211935
Name:SIMPSON COMMUNITY HEALTHCARE INC
Entity Type:Organization
Organization Name:SIMPSON COMMUNITY HEALTHCARE INC
Other - Org Name:SIMPSON GENERAL HOSPITAL PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDGEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-847-7130
Mailing Address - Street 1:1842 SIMPSON HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-3438
Mailing Address - Country:US
Mailing Address - Phone:601-847-7130
Mailing Address - Fax:601-847-7104
Practice Address - Street 1:1842 SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3438
Practice Address - Country:US
Practice Address - Phone:601-847-7130
Practice Address - Fax:601-847-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9015828Medicaid
MSC000143Medicare ID - Type Unspecified