NPIMap

Organization Active NPI

Warrington Clinic, P.a.

  • Family Medicine Physician
  • Marks, MS
National Provider Identifier
1164573176
Registry record updated Aug 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WARRINGTON CLINIC, P.A.
Practice address
1022 Martin Luther King Drive
Pob 289
Marks, MS 38646
Phone
(662) 326-3500
NPI assigned
Jan 16, 2007
Last updated
Aug 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2011

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

Authorized official

Name
Dr. Richard Edwin Waller, M.D.NPI 1821001041
Title
Vice President
Phone
(662) 326-3500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1022 Martin Luther King Drive
Pob 289
Marks, MS 38646

Mailing address

1022 Martin Luther King Drive
Pob 289
Marks, MS 38646
Phone (662) 326-3500

Other identifiers 1

IdentifierTypeStateIssuer
9011104MedicaidMS

National Provider Directory

National Provider Directory

Locations

1022 Martin Luther King Dr
Marks, MS 38646
Phone (662) 326-3500

Practitioners & affiliated clinicians

Practitioners 1

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312156800000",
    "number": "1164573176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 MARTIN LUTHER KING DRIVE",
            "address_2": "POB 289",
            "city": "MARKS",
            "state": "MS",
            "postal_code": "38646",
            "telephone_number": "662-326-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 MARTIN LUTHER KING DRIVE",
            "address_2": "POB 289",
            "city": "MARKS",
            "state": "MS",
            "postal_code": "38646",
            "telephone_number": "662-326-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARRINGTON CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-08-01",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "662-326-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9011104",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marks, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.