The Medical Clinic of Desoto Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

THE MEDICAL CLINIC OF DESOTO INC

Doing business as

The Medical Clinic

Practice address

6953 Oak Forest Dr
Olive Branch, MS 38654-1920

Phone

(662) 893-0450

Fax

(662) 893-0460

NPI assigned

Mar 30, 2007

Last updated

Oct 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Helen Gbemudu

Title

Administrator

Phone

(662) 893-0450

Specialties & licenses 1

Addresses

Other names 1

• The Medical Clinic Doing business as

Locations

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1093835209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6953 OAK FOREST DR",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541920",
            "telephone_number": "662-893-0450",
            "fax_number": "662-893-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6953 OAK FOREST DR",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541920",
            "telephone_number": "662-893-0450",
            "fax_number": "662-893-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEDICAL CLINIC OF DESOTO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "GBEMUDU",
        "authorized_official_first_name": "HELEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-893-0450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; 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.