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TYLERTOWN INTERNAL MEDICINE CLINIC
NPI 1144530403
Internal Medicine in Tylertown, MS

Active since October 20, 2010CLIA 25D0320087 · Waiver
200 HOSPITAL DR, TYLERTOWN, MS 39667(601) 876-5303 Get Directions Write a Review

NPPES record last updated: April 11, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tylertown Internal Medicine Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYLERTOWN INTERNAL MEDICINE CLINIC (NPI 1144530403) is a healthcare organization registered as an internal medicine in Tylertown, Mississippi and active in the NPI registry since October 2010. The organization holds a CLIA Waiver certificate valid through July 5, 2027 and lists Evan Dillard, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1144530403
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameWALTHAL RURAL HEALTH CLINIC
Location Address200 HOSPITAL DRTylertown, MS 39667-2020
Mailing AddressPo Box 677Tylertown, MS 39667-0677
Phone(601) 876-5303
Organization SubpartNo
Authorized OfficialEvan DillardPresident/ceo · (601) 288-4490
Enumeration DateOctober 20, 2010
Last NPPES UpdateApril 11, 2013
✔ NPI 1144530403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MS · 10220
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
200 HOSPITAL DR, Tylertown, MS 39667
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Other Names 1

Doing Business AsTylertown Internal Medicine Clinic

Other Identifiers 2

Other302G707791MS · Medicare Ptan
Medicaid07552559MS

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D0320087

Walthall Rural Health Clinic · Tylertown, MS
Active · expires Jul 5, 2027
CLIA Number25D0320087
Laboratory TypeRural Health Clinic
Certificate Effective DateJuly 6, 2025
Certificate Expiration DateJuly 5, 2027
Laboratory DirectorDr. Johnny R. Bullock
Laboratory Phone(601) 876-6006
Laboratory LocationWalthall Rural Health Clinic200 Hospital Dr, Tylertown, MS 39667
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FAMILY MEDICINE ASSOCIATES, PA
Family Medicine
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5835
REGINA A WILLIAMS CNP
Nurse Practitioner (Family)
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5303
CAROL HOBGOOD F.N.P.
Nurse Practitioner (Family)
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5303
MRS. ERIN BROOME RILEY MSN, APRN FNP-C
Nurse Practitioner (Family)
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5835
WALTHALL GENERAL HOSPITAL
General Acute Care Hospital (Critical Access)
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-2122
WALTHALL RURAL HEALTH CLINIC
Family Medicine
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5835
WALTHALL RURAL HEALTH CLINIC
Family Medicine
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5303
STEPHANIE WARNER MD
Internal Medicine
200 HOSPITAL DR
TYLERTOWN, MS 39667
Walthall County (601) 876-5303

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Walthal Rural Health Clinic's NPI number?

The NPI number for Walthal Rural Health Clinic is 1144530403. It was assigned to this organization in the NPPES registry on October 20, 2010. The provider is doing business as Tylertown Internal Medicine Clinic.

Where is Walthal Rural Health Clinic located?

Walthal Rural Health Clinic is located at 200 Hospital Dr, Tylertown, MS 39667. The listed phone number is (601) 876-5303.

What is Walthal Rural Health Clinic's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Walthal Rural Health Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D0320087) is associated with this NPI, valid through July 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Walthal Rural Health Clinic was last updated on April 11, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.