Active NPI
Su Clinica Corinth LLC
- Family Nurse Practitioner
- Corinth, MS
National Provider Identifier
1154299147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- SU CLINICA CORINTH LLC
- Practice address
- 504 S Tate St
Corinth, MS 38834-5532 - Phone
- (662) 415-9425
- NPI assigned
- Oct 29, 2025
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Maggie Macias, NP
- Title
- NP
- Phone
- (662) 415-9425
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Corinth, MS
- NPI 1972203404
Family, MS
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2335836 | Su Clinica Corinth, LLC | Certificate of waiver | Dec 17, 2027 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251216005058 | MS | Part B Supplier - Clinic/Group Practice | 7315432465 |
Receives reassigned benefits from 1 practitioner Practice locations: Corinth, MS |
National Provider Directory
National Provider DirectoryLocations
504 S Tate St
Corinth, MS 38834
Phone (662) 415-9425
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
504 S Tate St
Corinth, MS 38834-5532
Mailing address
504 S Tate St
Corinth, MS 38834-5532
Phone (662) 415-9425
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 3, 2025.
{
"created_epoch": "1761696000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1762128000000",
"number": "1154299147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 S TATE ST",
"city": "CORINTH",
"state": "MS",
"postal_code": "388345532",
"telephone_number": "662-415-9425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 S TATE ST",
"city": "CORINTH",
"state": "MS",
"postal_code": "388345532",
"telephone_number": "662-415-9425"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SU CLINICA CORINTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2025-10-29",
"last_updated": "2025-11-03",
"certification_date": "2025-11-03",
"status": "A",
"authorized_official_last_name": "MACIAS",
"authorized_official_first_name": "MAGGIE",
"authorized_official_title_or_position": "NP",
"authorized_official_telephone_number": "662-415-9425",
"authorized_official_credential": "NP"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Corinth, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.