NPIMap

Organization Active NPI

St Michaels Urgent Care of Hattiesburg

  • Family Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1124459136
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R875464 Issued in MS
Legal business name
ST MICHAELS URGENT CARE OF HATTIESBURG
Practice address
3700 Hardy St
Hattiesburg, MS 39402-1610
Phone
(601) 602-2014
Fax
(601) 602-2015
NPI assigned
Dec 2, 2013
Last updated
Sep 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
INLAND FAMILY PRACTICE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Authorized official

Name
Marva Joyce Cooley, CPC
Title
Credentialling Director
Phone
(601) 909-2539

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X R875464 MS Primary

Addresses

Primary practice location

3700 Hardy St
Hattiesburg, MS 39402-1610

Mailing address

3700 Hardy St
Hattiesburg, MS 39402-1610
Phone (601) 602-2014

National Provider Directory

National Provider Directory
Part of
Inland Fmly Prac CNTR LLC

Locations

85 Hal Crocker Rd
Ellisville, MS 39437
Phone (601) 719-0092

3700 Hardy St
Ste 10
Hattiesburg, MS 39402
Phone (601) 544-7012

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473120000000",
    "number": "1124459136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 HARDY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021610",
            "telephone_number": "601-602-2014",
            "fax_number": "601-602-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 HARDY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021610",
            "telephone_number": "601-602-2014",
            "fax_number": "601-602-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MICHAELS URGENT CARE OF HATTIESBURG",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INLAND FAMILY PRACTICE CENTER",
        "enumeration_date": "2013-12-02",
        "last_updated": "2016-09-06",
        "status": "A",
        "authorized_official_last_name": "COOLEY",
        "authorized_official_first_name": "MARVA",
        "authorized_official_middle_name": "JOYCE",
        "authorized_official_title_or_position": "CREDENTIALLING DIRECTOR",
        "authorized_official_telephone_number": "601-909-2539",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R875464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; 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.