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SOUTHERN FAMILY MEDICINE NPI 1982608691


NPI Information

NPI: 1982608691
Provider Name: SOUTHERN FAMILY MEDICINE
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 25D1026870

Address:
603 S HOLLY AVE
COLLINS, MS
ZIP 39428
Phone: (601) 765-9393
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SOUTHERN FAMILY MEDICINE is a medical specialty clinic center in Collins, MS. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). SOUTHERN FAMILY MEDICINE NPI is 1982608691. The provider is registered as an organization entity type.

The provider's business location address is:

603 S HOLLY AVE
COLLINS, MS
ZIP 39428-801
Phone: (601) 765-9393
Fax: (601) 765-9363

The provider's authorized official is Jason Gregory Beasley .
The authorized official title is Owner and has the following contact phone number (601) 765-9393.

The CLIA number assigned to this NPI record is 25D1026870 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/9/2005 and was last updated on 1/22/2019.


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
1261QM2500XClinic/CenterMedical SpecialtyYes

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
101588261MEDICAIDMISSISSIPPI
225D1026870OTHERCLIA

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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