Active NPI
First Choice Family Medical Clinic, LLC
- Family Nurse Practitioner
- Brooksville, MS
National Provider Identifier
1124644968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- FIRST CHOICE FAMILY MEDICAL CLINIC, LLC
- Practice address
- 75 Highway 388
Brooksville, MS 39739 - Phone
- (662) 738-5544
- NPI assigned
- Jun 17, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathy T Glover
- Title
- Business Office Manager
- Phone
- (662) 738-5454
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
75 Highway 388
Brooksville, MS 39739
Mailing address
PO Box 466
Macon, MS 39341-0466
Phone (662) 738-5454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210317002892 | MS | Part B Supplier - Clinic/Group Practice | 4284041278 |
Receives reassigned benefits from 3 practitioners Practice locations: Brooksville, MS |
National Provider Directory
National Provider DirectoryLocations
75 MS Highway 388
Brooksville, MS 39739
Phone (662) 738-5454
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": "1592352000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1647302400000",
"number": "1124644968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 466",
"city": "MACON",
"state": "MS",
"postal_code": "393410466",
"telephone_number": "662-738-5454",
"fax_number": "662-738-5457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 HIGHWAY 388",
"city": "BROOKSVILLE",
"state": "MS",
"postal_code": "39739",
"telephone_number": "662-738-5544"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIRST CHOICE FAMILY MEDICAL CLINIC, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-06-17",
"last_updated": "2022-03-15",
"certification_date": "2022-03-15",
"status": "A",
"authorized_official_last_name": "GLOVER",
"authorized_official_first_name": "KATHY",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
"authorized_official_telephone_number": "662-738-5454"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooksville, MS
- Brooksville Assisted Living Home Inc.
- Brooksville Clinical Laboratory, Inc.
- Brooksville Medical Clinic Inc
- Drayer Physical Therapy Institute LLC
- Drayer Physical Therapy Mississippi LLC
- First Choice Pharmacy, LLC
- Mary Ashley Hammons, MS CCC SLP
- Karla Jernigan, FNP
- Rachel Marie Lafferty, PT
- Macon City Drug Store, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.