MS LAKESIDE LLC — NPI 1700046521 (Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) in QUITMAN, MS)

CMS-1500 Box 24J / 33a • NPI

1700046521

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

314000000X (CMS A1[8])

Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)

Box 32 Service Location & ZIP+4

191 HIGHWAY 511, QUITMAN, MS, 39355-8320

✓ 9-Digit EDI 837 ZIP+4 (39355-8320)

Practice Phone & Referral Fax

(601) 766-2141

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1700046521 (MS LAKESIDE LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1700046521` (NPI-2 Organization / Facility)
Provider / Legal Name	MS LAKESIDE LLC
Plain-English Specialty	Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) NUCC Code: `314000000X` (Skilled Nursing Facility)
Certifying / Licensing Body	CMS Five-Star Quality Rating System / State Department of Health
Practice Location Address	191 HIGHWAY 511, QUITMAN, MS, 39355-8320
Practice Telephone / Fax	Tel: (601) 766-2141
Administrative Mailing Address	40 PALAFOX PL, PENSACOLA, FL, 32502-5697
Enumeration & Last Sync	Enumerated: 2008-06-16 \| CMS Record Updated: 2015-10-05
Authorized Official	JAMES RICHARDSON (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

191 HIGHWAY 511, QUITMAN, MS, 39355-8320

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Plain-English Taxonomy & CMS Crosswalk (314000000X)

What Does Taxonomy Code 314000000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 314000000X translates to:
"Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code A1[8] (Skilled Nursing Facility)
Certifying / Accrediting Authority: CMS Five-Star Quality Rating System / State Department of Health
Clinical Scope: Inpatient rehabilitation and 24-hour skilled nursing care following major surgery, stroke, or prolonged hospitalization.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MS LAKESIDE LLC)

Typical CPT / Diagnostic Procedures:

24-Hour Skilled Nursing Supervision, Enteral Nutrition & Pressure Ulcer Prevention
Post-Acute Orthopedic, Cardiac & Neurological Inpatient Rehabilitation

Common Therapeutic Classes:

Chronic Disease Maintenance Regimens, Analgesics & Thromboprophylaxis

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`314000000X` — Skilled Nursing Facility Plain English: Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MS LAKESIDE LLC (NPI #1700046521)