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CASSIDY BAYOU MEDICAL CLINIC NPI 1376181990


NPI Information

NPI: 1376181990
Provider Name: CASSIDY BAYOU MEDICAL CLINIC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 25D2052350

Address:
2372 US 49-E
SUMNER, MS
ZIP 38957
Phone: (662) 375-9310
Get Directions

CASSIDY BAYOU MEDICAL CLINIC is a family medicine in Sumner, MS. The provider is 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. CASSIDY BAYOU MEDICAL CLINIC NPI is 1376181990. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2372 US 49-E
SUMNER, MS
ZIP 38957
Phone: (662) 375-9310

The provider's authorized official is Sonja Bush Pennington .
The authorized official title is Provider/owner and has the following contact phone number (662) 375-2363.

The CLIA number assigned to this NPI record is 25D2052350 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/13/2019 and was last updated on 4/27/2020.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

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: 5/5/2024

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