NETTLETON FAMILY MEDICAL CLINIC, INC. Full NPI Record 1003005125
Clinic/Center - Primary Care in Nettleton, MS

Complete NPI Dataset

The following table represents the complete NPI 1003005125 dataset for Nettleton Family Medical Clinic, Inc. in 1495 MAPLE RD NETTLETON, MS 38858. The data table includes a list of all field names, values and definitions of the complete NPI record. The NPI dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1003005125The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code 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 (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameNETTLETON FAMILY MEDICAL CLINIC, INC.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address1495 MAPLE RDThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameNETTLETON, MSThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMSThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code388586026The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number6629639146The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number6629639186The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address1495 MAPLE RDThe first line 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 Business Practice Location Address City NameNETTLETONThe city name in the location address of the provider being identified.


Provider Business Practice Location Address State NameMSThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code388586026The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number6629639146The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6629639186The fax number associated with the location address of the provider being identified.
Provider Enumeration Date10/15/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date11/13/2012The date that a record was last updated or changed.
Authorized Official Last NameJUSTICEThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameANDREWThe first name of the authorized official.
Authorized Official Middle NameCURRYThe middle name of the authorized official.
Authorized Official Title or PositionOWNERThe title or position of the authorized official.
Authorized Official Telephone Number6629639146The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QP2300XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1R682403The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1MSThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2261QP2300X
Provider License Number 2R850606The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2MSThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2Y
Other Provider Identifier 100328681Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1MS
Is Organization SubpartN
Authorized Official Name Prefix TextMR.
Authorized Official Credential TextCFNP