NPIMap

Organization Active NPI

Primary Health Care, PLLC

  • Health Service Clinic/Center
  • Senatobia, MS
National Provider Identifier
1104074319
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
R672491 Issued in MS
Legal business name
PRIMARY HEALTH CARE, PLLC
Practice address
565 N Robinson St
Senatobia, MS 38668-2118
Phone
(662) 560-4313
Fax
(662) 560-4383
NPI assigned
Aug 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ms. Martha Moore Clinton, FNP-BC
Title
Owner / Operator
Phone
(662) 560-4313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X R672491 MS Primary

Addresses

Primary practice location

565 N Robinson St
Senatobia, MS 38668-2118

Mailing address

565 N Robinson St
Senatobia, MS 38668-2118
Phone (662) 560-4313

Other identifiers 4

IdentifierTypeStateIssuer
11618104OtherMSCAQH
S19627OtherMSUPIN
00116700MedicaidMS
R672491OtherMSLICENSE NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1104074319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 N ROBINSON ST",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386682118",
            "telephone_number": "662-560-4313",
            "fax_number": "662-560-4383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 N ROBINSON ST",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386682118",
            "telephone_number": "662-560-4313",
            "fax_number": "662-560-4383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "CLINTON",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "MOORE",
        "authorized_official_title_or_position": "OWNER / OPERATOR",
        "authorized_official_telephone_number": "662-560-4313",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MS",
            "license": "R672491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11618104",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "S19627",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00116700",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "R672491",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Senatobia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.