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NETTLETON FAMILY MEDICAL CLINIC INC. NPI 1003005125


NPI Profile

NPI: 1003005125
Provider Name: NETTLETON FAMILY MEDICAL CLINIC, INC.
Classification:Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
1495 MAPLE RD
NETTLETON, MS
ZIP 38858
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Phone: (662) 963-9146

NETTLETON FAMILY MEDICAL CLINIC, INC. is a primary care clinic center in Nettleton, MS. NETTLETON FAMILY MEDICAL CLINIC, INC. NPI is 1003005125. The provider is registered as an organization entity type.

The provider's business location address is:

1495 MAPLE RD
NETTLETON, MS
ZIP 38858-026
Phone: (662) 963-9146
Fax: (662) 963-9186

The provider's authorized official is Andrew Curry Justice .
The authorized official title is Owner and has the following contact phone number (662) 963-9146.

The enumeration date for this NPI number is 10/15/2007 and was last updated on 11/13/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QP2300XClinic/CenterPrimary CareR682403MISSISSIPPINo
2261QP2300XClinic/CenterPrimary CareR850606MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1512G700050MEDICARE UPINMISSISSIPPI
200328681MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/9/2021

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