Medical Foundation of South Ms

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MEDICAL FOUNDATION OF SOUTH MS

Doing business as

Long Beach Walk-In Clinic

Practice address

5120 Beatline Rd
Suite B
Long Beach, MS 39560-3815

Phone

(228) 868-4294

Fax

(228) 868-4293

NPI assigned

Jul 19, 2006

Last updated

May 23, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Randy Robinson

Title

Administrator

Phone

(228) 865-1453

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Long Beach Walk-In Clinic Doing business as

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

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1174542146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 31ST AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012750",
            "telephone_number": "228-865-1453",
            "fax_number": "228-865-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5120 BEATLINE RD",
            "address_2": "SUITE B",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395603815",
            "telephone_number": "228-868-4294",
            "fax_number": "228-868-4293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL FOUNDATION OF SOUTH MS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "228-865-1453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09083390",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Beach Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dustin Marmalich, MD
• Thea Rochelle Martin, LMT,
• Max M Edrington Optometrist PA
• Beth K McGee, LPN
• Emily McDermott McGinity, DPT
• Medical Foundation of South Ms (Children's Clinic)
• Medical Foundation of South Ms (Beatline Internal Medicine)
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)

• Family Medicine Physician in Long Beach, MS
• Providers in Long Beach, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.