Organization Active NPI

Gale Primary Care, LLC

  • Primary Care Clinic/Center
  • Moss Point, MS
National Provider Identifier
1083424857
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GALE PRIMARY CARE, LLC
Practice address
3702 Jefferson Ave
Moss Point, MS 39563-6218
Phone
(228) 641-1674
Fax
(228) 205-4593
NPI assigned
Jan 13, 2025
Last updated
Jan 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Authorized official

Name
Tammy Gale, FNP-BCNPI 1730821851
Title
Owner
Phone
(228) 641-1674

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

3702 Jefferson Ave
Moss Point, MS 39563-6218

Mailing address

3702 Jefferson Ave
Moss Point, MS 39563-6218
Phone (228) 641-1674

Other names 1

  • River City Primary Care and Wellness Center, LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250121002679 MS Part B Supplier - Clinic/Group Practice 9133658180 Receives reassigned benefits from 1 practitioner
Practice locations: Moss Point, MS

National Provider Directory

National Provider Directory

Locations

3702 Jefferson Ave
Pascagoula, MS 39563
Phone (228) 205-4592

Practitioners & affiliated clinicians

Practitioners 1

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": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1083424857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 JEFFERSON AVE",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636218",
            "telephone_number": "228-641-1674",
            "fax_number": "228-205-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 JEFFERSON AVE",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636218",
            "telephone_number": "228-641-1674",
            "fax_number": "228-205-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALE PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "GALE",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-641-1674",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River City Primary Care and Wellness Center, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Moss Point, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.