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INTERNAL MEDICINE CLINIC OF CLARKSDALE
NPI 1457554479
Specialist in Clarksdale, MS

Active since June 07, 2007CLIA 25D0958993 · Waiver
1967 HOSPITAL DR, CLARKSDALE, MS 38614(662) 624-5481 Get Directions Write a Review

NPPES record last updated: January 14, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Internal Medicine Clinic Of Clarksdale NPPES

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

INTERNAL MEDICINE CLINIC OF CLARKSDALE (NPI 1457554479) is a healthcare organization registered as a specialist in Clarksdale, Mississippi and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through October 12, 2026, maintains a secondary practice location in Clarksdale, and lists Sandra Blount, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1457554479
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameINTERNAL MEDICINE CLINIC OF CLARKSDALE
Location Address1967 HOSPITAL DRClarksdale, MS 38614-7203
Mailing Address1967 Hospital DrClarksdale, MS 38614-7203
Phone(662) 624-5481
Organization SubpartNo
Authorized OfficialSandra BlountOffice Manager · (662) 624-5481
Enumeration DateJune 7, 2007
Last NPPES UpdateJanuary 14, 2019
✔ NPI 1457554479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MS · 16074
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1967 HOSPITAL DR, Clarksdale, MS 38614
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Secondary Practice Location 1

Location 1785 Ohio Ave Ste 2BClarksdale, MS 38614-6216 · Phone (662) 624-5481

Other Identifiers 2

Medicaid07922048MS
Medicaid00119669MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 25D0958993

Internal Medicine Clinic · Clarksdale, MS
Active · expires Oct 12, 2026
CLIA Number25D0958993
Laboratory TypePhysician Office
Certificate Effective DateOctober 13, 2024
Certificate Expiration DateOctober 12, 2026
Laboratory DirectorIrene S. Buckner
Laboratory Phone(662) 624-5481
Laboratory LocationInternal Medicine Clinic1967 Hospital Drive, Clarksdale, MS 38614
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 3

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

IRENE BUCKNER M.D.
Specialist
1967 HOSPITAL DR
CLARKSDALE, MS 38614
Coahoma County (662) 624-5481
LASHONDA LASHAY BRADLEY FNP-C
Nurse Practitioner (Family)
1967 HOSPITAL DR
CLARKSDALE, MS 38614
Coahoma County (662) 624-5481
MATURE CARE, LLC
Clinic/Center (Adult Day Care)
1967 HOSPITAL DR
CLARKSDALE, MS 38614
Coahoma County (662) 627-1500

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 Internal Medicine Clinic Of Clarksdale's NPI number?

The NPI number for Internal Medicine Clinic Of Clarksdale is 1457554479. It was assigned to this organization in the NPPES registry on June 7, 2007.

Where is Internal Medicine Clinic Of Clarksdale located?

Internal Medicine Clinic Of Clarksdale is located at 1967 Hospital Dr, Clarksdale, MS 38614. The listed phone number is (662) 624-5481.

What is Internal Medicine Clinic Of Clarksdale's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Internal Medicine Clinic Of Clarksdale hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D0958993) is associated with this NPI, valid through October 12, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Internal Medicine Clinic Of Clarksdale 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 Internal Medicine Clinic Of Clarksdale 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 Internal Medicine Clinic Of Clarksdale was last updated on January 14, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.