Healthy Living Family Medical Center LLC
Organization Active NPI Rural Health Clinic/Center · Gunnision, MS
NPI 1154845840 · NPPES record last updated Feb 3, 2023
Key facts
- NPI
- 1154845840
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- HEALTHY LIVING FAMILY MEDICAL CENTER LLC
- Practice address
- 820 Ashland Avenue
Gunnision, MS 38746 - Phone
- (662) 987-5023
- Fax
- (662) 987-5025
- NPI assigned
- Aug 3, 2017
- Organization subpart
- No
Authorized official
- Name
- Wycondaroga E Thomas, FNP-C
- Title
- Nurse Practitioner/Owner
- Phone
- (662) 402-0174
Practitioners 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170918002897 | MS | Part B Supplier - Clinic/Group Practice | 7911271747 | Practice locations: Gunnison, MS |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/19142/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Family Nurse Practitioner |
363LF0000X | 890243 | MS |
Addresses
Primary practice location
820 Ashland Avenue
Gunnision, MS 38746
Mailing address
PO Box 357
Gunnison, MS 38746-0357
Phone (662) 987-5023
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04784050 | Medicaid | MS |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.