NPIMap

Organization Active NPI

Rosedale Family Medical Center, P.C.

  • Family Medicine Physician
  • Rosedale, MS
National Provider Identifier
1043223340
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
09592 Issued in MS
Legal business name
ROSEDALE FAMILY MEDICAL CENTER, P.C.
Practice address
512 Levee St.
Rosedale, MS 38769-0310
Phone
(662) 759-6806
Fax
(662) 759-6771
NPI assigned
Aug 15, 2006
Last updated
Apr 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Authorized official

Name
Dr. John William Lewis Jr., M.D.NPI 1073536132
Title
President
Phone
(662) 759-6806

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 09592 MS Primary

Addresses

Primary practice location

512 Levee St.
Rosedale, MS 38769-0310

Mailing address

P.O.Box 310
Rosedale, MS 38769-0310
Phone (662) 759-6806

Other identifiers 1

IdentifierTypeStateIssuer
09014540MedicaidMS

National Provider Directory

National Provider Directory

Locations

512 Levee St
Rosedale, MS 38769
Phone (662) 759-6603

512 Levee St
#310
Rosedale, MS 38769
Phone (662) 759-6806

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1043223340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O.BOX 310",
            "city": "ROSEDALE",
            "state": "MS",
            "postal_code": "387690310",
            "telephone_number": "662-759-6806",
            "fax_number": "662-759-6771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 LEVEE ST.",
            "city": "ROSEDALE",
            "state": "MS",
            "postal_code": "387690310",
            "telephone_number": "662-759-6806",
            "fax_number": "662-759-6771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEDALE FAMILY MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-759-6806",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "09592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014540",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rosedale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.