OLIVE BRANCH FAMILY MEDICAL CENTER - NPI 1629018478 - Family Medicine in Olive Branch, MS

Q: What is the provider's specialty?

The provider's specialty is Family Medicine with taxonomy code 207Q00000X.

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About Olive Branch Family Medical Center NPPES

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

OLIVE BRANCH FAMILY MEDICAL CENTER (NPI 1629018478) is a healthcare organization registered as a family medicine in Olive Branch, Mississippi and active in the NPI registry since June 2006. The organization holds a CLIA Certificate of Compliance certificate valid through June 11, 2028, maintains a secondary practice location in Olive Branch, and lists Amy Green, Business Office Manager, as its authorized official.

NPPES Registry Identity

NPI1629018478

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameOLIVE BRANCH FAMILY MEDICAL CENTER

Location Address9075 SANDIDGE CENTER CVOlive Branch, MS 38654-3514

Mailing Address9075 Sandidge Center CvOlive Branch, MS 38654-3514 · (662) 895-4949 · Fax (662) 895-6776

Phone(662) 895-4949

Fax(662) 895-6776

Organization SubpartNo

Authorized OfficialAmy GreenBusiness Office Manager · (662) 893-8484

Enumeration DateJune 8, 2006

Last NPPES UpdateDecember 21, 20203 updates tracked since enumeration

NPPES CertifiedDecember 21, 2020

✔ NPI 1629018478 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

9075 SANDIDGE CENTER CV, Olive Branch, MS 38654

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Secondary Practice Location 1

Location 18135 Goodman RdOlive Branch, MS 38654-2103 · Phone (662) 895-4949 · Fax (662) 893-1103

Other Identifiers 1

Other1629018478Npi

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

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 Compliance 25D0927270

Olive Branch Family Medical Center · Olive Branch, MS

Active · expires Jun 11, 2028

CLIA Number25D0927270

Laboratory TypePhysician Office

Certificate Effective DateJune 12, 2026

Certificate Expiration DateJune 11, 2028

Laboratory DirectorDr. Randall T. Huling

Laboratory Phone(662) 895-4949

Laboratory LocationOlive Branch Family Medical Center9075 Sandidge Center Cove, Olive Branch, MS 38654

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 10

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

KORI SWEARENGEN FNP-BC

Nurse Practitioner (Family)