BLACKWELL'S FAMILY MEDICINE LLC
NPI 1366003436
Clinic/Center - Primary Care in Tylertown, MS

Q: What is Blackwell's Family Medicine LLC's NPI number?

The NPI number for Blackwell's Family Medicine LLC is 1366003436. It was assigned to this organization in the NPPES registry on June 27, 2019.

Q: What is Blackwell's Family Medicine LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Active since June 27, 2019CLIA 25D2184690 · Waiver

107 BALL AVE, TYLERTOWN, MS 39667(601) 303-8264 Get Directions Write a Review

NPPES record last updated: March 15, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 15, 2021, Dec 19, 2019 (2 updates tracked since 2019).

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About Blackwell's Family Medicine Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACKWELL'S FAMILY MEDICINE LLC (NPI 1366003436) is a healthcare organization registered as a primary care in Tylertown, Mississippi and active in the NPI registry since June 2019. The organization holds a CLIA Waiver certificate valid through May 21, 2028 and lists Chrisotpher William Blackwell, Owner, Provider, as its authorized official.

NPPES Registry Identity

NPI1366003436

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameBLACKWELL'S FAMILY MEDICINE LLC

Location Address107 BALL AVETylertown, MS 39667-2101

Mailing Address171 Pigott Easterling RdTylertown, MS 39667-7222 · (601) 303-8264

Phone(601) 303-8264

Organization SubpartNo

Authorized OfficialChrisotpher William BlackwellOwner, Provider · (601) 377-1975

Enumeration DateJune 27, 2019

Last NPPES UpdateMarch 15, 20212 updates tracked since enumeration

NPPES CertifiedMarch 15, 2021

✔ NPI 1366003436 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

107 BALL AVE, Tylertown, MS 39667

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2184690

Blackwell's Family Medicine Clinic · Tylertown, MS

Active · expires May 21, 2028

CLIA Number25D2184690

Laboratory TypePractitioner Other

Certificate Effective DateMay 22, 2026

Certificate Expiration DateMay 21, 2028

Laboratory DirectorPatricia J. Herrington

Laboratory Phone(601) 377-1975

Laboratory LocationBlackwell's Family Medicine Clinic107 Ball Ave, Tylertown, MS 39667

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBIN ELIZABETH CAMPBELL CNP

Nurse Practitioner (Family)

107 BALL AVE
TYLERTOWN, MS 39667

Walthall County (601) 377-1975

CHRISTOPHER BLACKWELL CNP

Nurse Practitioner (Family)

107 BALL AVE
TYLERTOWN, MS 39667

Walthall County (601) 377-1975

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blackwell's Family Medicine LLC's NPI number?

The NPI number for Blackwell's Family Medicine LLC is 1366003436. It was assigned to this organization in the NPPES registry on June 27, 2019.

Where is Blackwell's Family Medicine LLC located?

Blackwell's Family Medicine LLC is located at 107 Ball Ave, Tylertown, MS 39667. The listed phone number is (601) 303-8264.

What is Blackwell's Family Medicine LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Blackwell's Family Medicine LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2184690) is associated with this NPI, valid through May 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Blackwell's Family Medicine LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Blackwell's Family Medicine LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Blackwell's Family Medicine LLC was last updated on March 15, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.