Organization Active NPI

Medical Foundation of South Ms

  • Internal Medicine Physician
  • Biloxi, MS
National Provider Identifier
1003915729
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEDICAL FOUNDATION OF SOUTH MS
Practice address
2771 Pass Rd
Suite B
Biloxi, MS 39531-2600
Phone
(228) 385-4645
Fax
(228) 385-4695
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Randy Robinson
Title
Administrator
Phone
(228) 865-1453

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2771 Pass Rd
Suite B
Biloxi, MS 39531-2600

Mailing address

1612 31St Ave
Gulfport, MS 39501-2750
Phone (228) 865-1453

Other identifiers 1

IdentifierTypeStateIssuer
04023236MedicaidMS

Other names 1

  • Pass Road Walk-In Clinic Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1003915729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 31ST AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012750",
            "telephone_number": "228-865-1453",
            "fax_number": "228-865-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2771 PASS RD",
            "address_2": "SUITE B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395312600",
            "telephone_number": "228-385-4645",
            "fax_number": "228-385-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL FOUNDATION OF SOUTH MS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "228-865-1453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04023236",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pass Road Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Biloxi, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.