Trace Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TRACE MEDICAL CLINIC

Practice address

530 Veterans Memorial Dr
Kosciusko, MS 39090-3858

Phone

(662) 289-9155

Fax

(662) 289-7752

NPI assigned

Apr 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Edward E Bryant, MDNPI 1154478410

Title

President/Owner

Phone

(662) 289-9155

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward E Bryant, MD

  • Family Medicine Physician
  • Kosciusko, MS
  • NPI 1154478410
  NPD Authorized official

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1033383815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 VETERANS MEMORIAL DR",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903858",
            "telephone_number": "662-289-9155",
            "fax_number": "662-289-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 VETERANS MEMORIAL DR",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903858",
            "telephone_number": "662-289-9155",
            "fax_number": "662-289-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "662-289-9155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016283",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela M Thomas, OD
• Hollie Thomas
• Latoya R Thompson
• Emalee Malaina Thrash, OTD, OTR/L
• Hannah Tingle
• Trace Medical Clinic, PLLC
• Kyla Sharkeya Triplett
• Trucare Nursing Service LLC
• Gary Tucker
• Betty H. Turner, MD

• Family Medicine Physician in Kosciusko, MS
• Providers in Kosciusko, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.