PHYLLIS G KOONCE NPI 1891911186

NPI Information

  • NPI: 1891911186
  • Provider Name: PHYLLIS G KOONCE
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • Doing Business As: COTTON PLANT FAMILY CLINIC
  • Address: 100 COUNTY ROAD 714
    BLUE MOUNTAIN, MS
    ZIP 38610
  • Phone: (662) 538-4111

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NPI Details

PHYLLIS G KOONCE is a rural health clinic center in Blue Mountain, MS. PHYLLIS G KOONCE NPI is 1891911186. The provider is registered as an organization entity type.
The provider Is Doing Business As Cotton Plant Family Clinic.

The provider's business location address is:

100 COUNTY ROAD 714
BLUE MOUNTAIN, MS
ZIP 38610-743
Phone: (662) 538-4111
Fax: (662) 538-4128

The provider's authorized official is Phyllis G Koonce .
The authorized official title is Owner Sole Provider and has the following contact phone number (662) 538-4111.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 7/7/2008.

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
1261QR1300XClinic/CenterRural HealthR125960MISSISSIPPIYes

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
106577891MEDICAIDMISSISSIPPI
2S34270MEDICARE UPINMISSISSIPPI
3258973MEDICARE ID-TYPE UNSPECIFIEDMISSISSIPPI

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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