NPIMap

Organization Active NPI

McComb Urology Clinic, P.a.

  • Specialist
  • McComb, MS
National Provider Identifier
1073600409
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
7944 Issued in MS
Legal business name
MCCOMB UROLOGY CLINIC, P.A.
Practice address
300 Rawls Dr Ste 1000
McComb, MS 39648-2861
Phone
(601) 684-1261
Fax
(601) 684-3649
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Jose Benjamin Simo, MD
Title
President
Phone
(601) 684-1261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 7944 MS Primary

Addresses

Primary practice location

300 Rawls Dr Ste 1000
McComb, MS 39648-2861

Mailing address

300 Rawls Dr Ste 1000
McComb, MS 39648-2861
Phone (601) 684-1261

Other identifiers 1

IdentifierTypeStateIssuer
00016344MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073600409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RAWLS DR STE 1000",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482861",
            "telephone_number": "601-684-1261",
            "fax_number": "601-684-3649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RAWLS DR STE 1000",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482861",
            "telephone_number": "601-684-1261",
            "fax_number": "601-684-3649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCOMB UROLOGY CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SIMO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-684-1261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MS",
            "license": "7944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00016344",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McComb, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.