PREMISE HEALTH OF MISSISSIPPI MEDICAL PC
NPI 1619640562
Clinic/Center - Multi-Specialty in Forest, MS
NPI Status: Active since July 27, 2021
Contact Information
1001 FOUNTAIN DR
FOREST, MS
ZIP 39074
Phone: (601) 469-0234
- Organization
- Clinic/Center
- Multi-Specialty
- CLIA Number: 25D2003849
- CLIA Cert. Type: Industrial
- CLIA Exp. Date: 02-18-2028
About PREMISE HEALTH OF MISSISSIPPI MEDICAL PC
This page provides the complete NPI Profile along with additional information for Premise Health Of Mississippi Medical Pc, a provider established in Forest, Mississippi operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1619640562 assigned on July 2021. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated February 2026. The provider's
- NPI
- 1619640562
- Provider Legal Name
- PREMISE HEALTH OF MISSISSIPPI MEDICAL PC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 1001 FOUNTAIN DR FOREST, MS 39074
- Location Phone
- (601) 469-0234
- Mailing Address
- 5500 MARYLAND WAY BRENTWOOD, TN 37027
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-27-2021
- Last Update Date
- 02-12-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 25D2003849
- Facility Type
- Industrial
- Certificate Effective Date
- February 19, 2026
- Certificate Expiration Date
- February 18, 2028
- Laboratory Director
- DR. KEVIN YOUNG
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Premise Health Of Mississippi Medical Pc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1619640562, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 58. The final step is to find the difference between that total and the next multiple of ten (60 - 58 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 58 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1619640562, enumerated as an "organization" on July 27, 2021.
The provider is located at 1001 FOUNTAIN DR FOREST, MS 39074 and the phone number is (601) 469-0234.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
