NETTLETON FAMILY MEDICAL CLINIC, INC. NPI 1003005125

Clinic/Center (Primary Care) in Nettleton, MS

About NETTLETON FAMILY MEDICAL CLINIC, INC.

Nettleton Family Medical Clinic, Inc. is a provider in Nettleton, MS. The NPI number assigned to this provider is 1003005125. The practitioner's primary taxonomy code is Clinic/Center (261QP2300X). The provider is registered as an organization and their NPI record was last updated 5 years ago.

NPI1003005125 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameNETTLETON FAMILY MEDICAL CLINIC, INC.
Provider Location Address1495 MAPLE RD NETTLETON, MS 38858 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address1495 MAPLE RD NETTLETON, MS, MS 38858 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date10-15-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date11-13-2012 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

NETTLETON FAMILY MEDICAL CLINIC, INC.
1495 MAPLE RD
NETTLETON, MS
ZIP 38858
Phone: (662) 963-9146
Fax: (662) 963-9186
Get Directions

Mailing Address

NETTLETON FAMILY MEDICAL CLINIC, INC.
1495 MAPLE RD
NETTLETON, MS, MS
ZIP 38858
Phone: (662) 963-9146
Fax: (662) 963-9186

Primary Taxonomy

Taxonomy Code261QP2300X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationPrimary Care
License No.R850606
License StateMS

Authorized Official

Authorized Official NameMR. ANDREW CURRY JUSTICE CFNP Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleOWNER
Authorized Official Phone(662) 963-9146

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareR682403MSNo

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
512G700050MEDICARE UPIN (02)MS
00328681MEDICAID (05)MS

Map Location


NETTLETON FAMILY MEDICAL CLINIC, INC. address is 1495 MAPLE RD NETTLETON, MS 38858

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1568610806MR. ANDREW C JUSTICE CFNP
Individual
Nurse Practitioner (Family)1495 MAPLE RD
NETTLETON, MS 38858
(662) 963-9146
1639279425 KAWANNA CORRINE MALONE C.F.N.P.
Individual
Nurse Practitioner (Family)1495 MAPLE RD
NETTLETON, MS 38858
(662) 963-9146