OrganizationActive
Ellisville State School
NPI 1568468080 · Clinic/Center · Ellisville, MS
Provider details
- NPI number
- 1568468080
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Suzie Lassiter, Director(601) 477-9384
- License
- C00638 (MS)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1101 Hwy 11 S
Ellisville, MS 39437-4444
Phone: (601) 477-9384
Fax: (601) 477-5700
Approximate (ZIP-level) locationGet directions
Mailing address
1101 Hwy 11 S
Ellisville, MS 39437-4444
Registry dates
- Enumerated
- 2005-06-21
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.