TYLER HOLMES MEMORIAL HOSPITAL NPI 1730367459

NPI Information

NPI: 1730367459
Provider Name: TYLER HOLMES MEMORIAL HOSPITAL

Other Name: CROSSROADS FAMILY MEDICINE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
702 WOODLAND DR
WINONA, MS
ZIP 38967
Phone: (662) 283-8205
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TYLER HOLMES MEMORIAL HOSPITAL is a rural health clinic center in Winona, MS. TYLER HOLMES MEMORIAL HOSPITAL NPI is 1730367459. The provider is registered as an organization entity type.
The provider Other Name Is Crossroads Family Medicine.

The provider's business location address is:

702 WOODLAND DR
WINONA, MS
ZIP 38967-530
Phone: (662) 283-8205
Fax: (662) 283-6747

The provider's authorized official is Memorie Lyons .
The authorized official title is Clinic Director and has the following contact phone number (662) 283-6119.

The CLIA number assigned to this NPI record is 25D1081237 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/5/2008 and was last updated on 1/29/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			No
2	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	008203508	MEDICAID	MISSISSIPPI
2	2070889	OTHER	MISSISSIPPI	WELLCARE
3	8009711	MEDICAID	MISSISSIPPI
4	005330334	MEDICAID	MISSISSIPPI
5	007870552	MEDICAID	MISSISSIPPI
6	1497164446	OTHER	MISSISSIPPI	NPI
7	1730367459	OTHER	MISSISSIPPI	NPI
8	1730550419	OTHER	MISSISSIPPI	NPI
9	200007660	MEDICAID	MISSISSIPPI
10	2163489	OTHER	MISSISSIPPI	WELLCARE
11	08203508	MEDICAID	MISSISSIPPI
12	1659550127	OTHER	MISSISSIPPI	NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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