CHARLES LARRY MCCULLOUCH MD NPI 1710964754

NPI Information

  • NPI: 1710964754
  • Provider Name: CHARLES LARRY MCCULLOUCH, MD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1560 NORTH OLIVER ST.
    BROOKSVILLE, MS
    ZIP 39739
  • Phone: (662) 738-4424

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NPI Details

Charles Larry Mccullouch, MD is a family medicine in Brooksville, 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. Charles Larry Mccullouch, MD NPI is 1710964754. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1560 NORTH OLIVER ST.
BROOKSVILLE, MS
ZIP 39739
Phone: (662) 738-4424
Fax: (662) 738-4615

The NPI 1710964754 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Emergency department visit for problem of moderate severity (HCPCS:99283)
  • Emergency department visit for problem of mild severity (HCPCS:99281)
  • Emergency department visit for problem of high severity (HCPCS:99284)
  • Emergency department visit for problem of mild to moderate severity (HCPCS:99282)

The enumeration date for this NPI number is 12/30/2005 and was last updated on 6/19/2018.

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 Medicine13953MISSISSIPPIYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100125739MEDICAIDMISSISSIPPI
2P00147884OTHERRAILROAD MEDICARE

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: 11/21/2025

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