NPIMap

Organization Active NPI

The Wren Clinic, PC

  • Dermatology Physician
  • Tupelo, MS
National Provider Identifier
1063639185
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
14798 Issued in MS
Legal business name
THE WREN CLINIC, PC
Practice address
874 Barnes Crossing Rd
Tupelo, MS 38804-0909
Phone
(662) 891-2999
Fax
(662) 286-0106
NPI assigned
Apr 19, 2007
Last updated
Jan 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Authorized official

Name
Dr. Charles M. Wren II, D.O.NPI 1629016126
Title
President
Phone
(662) 891-2999

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
Dermatology Physician 207N00000X 14798 MS Primary

Addresses

Primary practice location

874 Barnes Crossing Rd
Tupelo, MS 38804-0909

Mailing address

PO Box 1530
Dept 185
Southaven, MS 38671-1530
Phone (662) 891-2999

Other names 1

  • Northeast Mississippi Dermatology Center, PC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1063639185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1530",
            "address_2": "DEPT 185",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711530",
            "telephone_number": "662-891-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 BARNES CROSSING RD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388040909",
            "telephone_number": "662-891-2999",
            "fax_number": "662-286-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WREN CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "WREN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-891-2999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MS",
            "license": "14798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Mississippi Dermatology Center, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; 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.