Organization Active NPI

Su Clinica Corinth LLC

  • Family Nurse Practitioner
  • Corinth, MS
National Provider Identifier
1154299147
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
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, NPNPI 1972203404
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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2335836Su Clinica Corinth, LLC504 S Tate St, Corinth, MS 38834Certificate of waiverDec 17, 2027

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251216005058 MS Part B Supplier - Clinic/Group Practice 7315432465 Receives reassigned benefits from 1 practitioner
Practice locations: Corinth, MS

National Provider Directory

National Provider Directory

Locations

504 S Tate St
Corinth, MS 38834
Phone (662) 415-9425

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

NPPES NPI Registry

Primary 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.

Verify at the official NPI Registry.