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ELLISVILLE MEDICAL CLINIC
NPI 1942554761
Family Medicine in Ellisville, MS

Active since October 31, 2012CLIA 25D2070626 · Waiver
1203 AVENUE B, ELLISVILLE, MS 39437(601) 477-8553(601) 477-9158 Get Directions Write a Review

NPPES record last updated: October 31, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ellisville Medical Clinic NPPES

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

ELLISVILLE MEDICAL CLINIC (NPI 1942554761) is a healthcare organization registered as a family medicine in Ellisville, Mississippi and active in the NPI registry since October 2012. The organization holds a CLIA Waiver certificate valid through December 19, 2027 and lists James T Canizaro, C.f.o. / Vice President, as its authorized official.

NPPES Registry Identity

NPI1942554761
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTH CENTRAL REGIONAL MEDICAL CENTER
Location Address1203 AVENUE BEllisville, MS 39437-2080
Mailing Address1203 Avenue BEllisville, MS 39437-2080 · (601) 477-8553 · Fax (601) 477-9158
Phone(601) 477-8553
Fax(601) 477-9158
Organization SubpartNo
Authorized OfficialJames T CanizaroC.f.o. / Vice President · (601) 399-6139
Enumeration DateOctober 31, 2012
✔ NPI 1942554761 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedPediatrics · Adolescent MedicineTaxonomy 2080A0000X
1203 AVENUE B, Ellisville, MS 39437
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Other Names 1

Doing Business AsEllisville Medical Clinic

Other Identifiers 1

Medicaid09014135MS

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 25D2070626

Ellisville Pediatric Clinic · Ellisville, MS
Active · expires Dec 19, 2027
CLIA Number25D2070626
Laboratory TypeRural Health Clinic
Certificate Effective DateDecember 20, 2025
Certificate Expiration DateDecember 19, 2027
Laboratory DirectorMargaret Williams
Laboratory Phone(601) 477-3550
Laboratory LocationEllisville Pediatric Clinic1203 Avenue B Suite, Ellisville, MS 39437
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 7

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

HANNAH JOELLE CAMPBELL RAMSEY DO
Family Medicine
1203 AVENUE B
ELLISVILLE, MS 39437
Jones County (601) 477-8553
SOUTH CENTRAL CLINICS, INC.
Obstetrics & Gynecology
1203 AVENUE B, SUITE 300
ELLISVILLE, MS 39437
Jones County (601) 477-2226
BENJAMIN MICHAEL WEBER M.D.
Obstetrics & Gynecology
1203 AVENUE B, STE 300
ELLISVILLE, MS 39437
Jones County (601) 477-2226
MRS. VICKI HAMPTON FNP
Nurse Practitioner
1203 AVENUE B
ELLISVILLE, MS 39437
Jones County (601) 477-8553
SOUTH CENTRAL CLINICS, INC
Family Medicine
1203 AVENUE B
ELLISVILLE, MS 39437
Jones County (601) 477-8553
DR. MICHAEL CASEY MD
Family Medicine
1203 AVENUE B
ELLISVILLE, MS 39437
Jones County (601) 477-8553
DR. PATRICIA A. TIBBS M.D.
Pediatrics
1203 AVENUE B
ELLISVILLE, MS 39437
Jones County (601) 477-3550

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 South Central Regional Medical Center's NPI number?

The NPI number for South Central Regional Medical Center is 1942554761. It was assigned to this organization in the NPPES registry on October 31, 2012. The provider is doing business as Ellisville Medical Clinic.

Where is South Central Regional Medical Center located?

South Central Regional Medical Center is located at 1203 Avenue B, Ellisville, MS 39437. The listed phone number is (601) 477-8553.

What is South Central Regional Medical Center's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does South Central Regional Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2070626) is associated with this NPI, valid through December 19, 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 South Central Regional Medical Center was last updated on October 31, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.