NPIMap

Organization Active NPI

Thaxton Family Medical Clinic LLC

  • Primary Care Nurse Practitioner
  • Thaxton, MS
National Provider Identifier
1124505912
Registry record updated Jul 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
901818 Issued in MS
Legal business name
THAXTON FAMILY MEDICAL CLINIC LLC
Practice address
11145 Highway 6 W
Thaxton, MS 38871-9024
Phone
(662) 489-8500
Fax
(662) 489-8600
NPI assigned
Jul 24, 2018
Last updated
Jul 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2018

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

Authorized official

Name
Mr. Kevin Floyd, NP-CNPI 1174075220
Title
Provider/Managing Member
Phone
(662) 213-7890

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 901818 MS
Primary Care Nurse Practitioner 363LP2300X 901818 MS Primary

Addresses

Primary practice location

11145 Highway 6 W
Thaxton, MS 38871-9024

Mailing address

11145 Highway 6 W
Thaxton, MS 38871-9024
Phone (662) 489-8500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180920000369 MS Part B Supplier - Clinic/Group Practice 7315298973 Receives reassigned benefits from 1 practitioner
Practice locations: Thaxton, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532390400000",
    "number": "1124505912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11145 HIGHWAY 6 W",
            "city": "THAXTON",
            "state": "MS",
            "postal_code": "388719024",
            "telephone_number": "662-489-8500",
            "fax_number": "662-489-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11145 HIGHWAY 6 W",
            "city": "THAXTON",
            "state": "MS",
            "postal_code": "388719024",
            "telephone_number": "662-489-8500",
            "fax_number": "662-489-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAXTON FAMILY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A",
        "authorized_official_last_name": "FLOYD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PROVIDER/MANAGING MEMBER",
        "authorized_official_telephone_number": "662-213-7890",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "901818",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "901818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thaxton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.