Integrated Medical and Wellness Clinic of Mississippi LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC

Practice address

212 Draperton CT
Ridgeland, MS 39157-3905

Phone

(769) 300-9040

Fax

(769) 300-9055

NPI assigned

Oct 27, 2021

Organization subpart

No

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

Authorized official

Name

Mr. David F. Rowe

Title

Owner, Authorized Official

Phone

(228) 248-0561

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jena Naomi Smith, NP-C

  • Family Nurse Practitioner
  • Ridgeland, MS
  • NPI 1558370205
  NPD (past)

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1104580943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2556 MARCIA CT",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395312352",
            "telephone_number": "228-248-0561",
            "fax_number": "228-248-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 DRAPERTON CT",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391573905",
            "telephone_number": "769-300-9040",
            "fax_number": "769-300-9055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "ROWE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "OWNER, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "228-248-0561",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.