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JAMES T. CHAMPION NURSING FACILITY
NPI 1629394853
Nursing Facility/Intermediate Care Facility in Meridian, MS

Active since April 13, 2010CLIA 25D2002517 · Waiver
4555 HIGHLAND PARK DR, MERIDIAN, MS 39307(601) 581-7600(601) 581-7676 Get Directions Write a Review

NPPES record last updated: May 12, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About James T. Champion Nursing Facility NPPES

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

JAMES T. CHAMPION NURSING FACILITY (NPI 1629394853) is a healthcare organization registered as a nursing facility/intermediate care facility in Meridian, Mississippi and active in the NPI registry since April 2010. The organization holds a CLIA Waiver certificate valid through January 19, 2028 and lists Charles Carlisle, Hospital Director, as its authorized official.

NPPES Registry Identity

NPI1629394853
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NameEAST MISSISSIPPI STATE HOSPITAL
Location Address4555 HIGHLAND PARK DRMeridian, MS 39307-5429
Mailing AddressPo Box 4128Meridian, MS 39304-4128 · (601) 581-7600 · Fax (601) 581-7676
Phone(601) 581-7600
Fax(601) 581-7676
Organization SubpartYes
Authorized OfficialCharles CarlisleHospital Director · (601) 581-7878
Enumeration DateApril 13, 2010
Last NPPES UpdateMay 12, 2020
NPPES CertifiedMay 12, 2020
✔ NPI 1629394853 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
Taxonomy Code313M00000X
License✔ Licensed in MS · 1034
Definition
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
4555 HIGHLAND PARK DR, Meridian, MS 39307
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Other Names 1

Doing Business AsJames T. Champion Nursing Facility

Other Identifiers 1

Medicaid01831556MS

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 25D2002517

James T Champion Nursing Facility · Meridian, MS
Active · expires Jan 19, 2028
CLIA Number25D2002517
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJanuary 20, 2026
Certificate Expiration DateJanuary 19, 2028
Laboratory DirectorDr. Michael Light
Laboratory Phone(601) 581-8450
Laboratory LocationJames T Champion Nursing Facility1455 North Lakeland Drive, Meridian, MS 39304
CLIA data matches this NPI record on: Name
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.

MAGNOLIA CLINIC
Clinic/Center
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 481-1135
DR. KIM ELLIOT NAGEL MD
Psychiatry & Neurology (Psychiatry)
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 581-7687
ANGELA MARSHON MARS LPC
Counselor (Professional)
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 581-7550
DONALD MCKAY RPH
Pharmacist
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 581-7826
PHYSICIAN GROUP
Clinic/Center (Multi-Specialty)
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 581-7969
VICKIE L WARREN NP
Nurse Practitioner (Adult Health)
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 581-7600
MS. STELLA ELIZABETH GERVIN-WARD LCSW
Social Worker (Clinical)
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 581-7775
RAMIRO J MARTINEZ
Family Medicine
4555 HIGHLAND PARK DR
MERIDIAN, MS 39307
Lauderdale County (601) 482-6186

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 East Mississippi State Hospital's NPI number?

The NPI number for East Mississippi State Hospital is 1629394853. It was assigned to this organization in the NPPES registry on April 13, 2010. The provider is doing business as James T. Champion Nursing Facility.

Where is East Mississippi State Hospital located?

East Mississippi State Hospital is located at 4555 Highland Park Dr, Meridian, MS 39307. The listed phone number is (601) 581-7600.

What is East Mississippi State Hospital's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Does East Mississippi State Hospital hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2002517) is associated with this NPI, valid through January 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for East Mississippi State Hospital was last updated on May 12, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.