NPIMap

Organization Active NPI

Quad Intermed Company LLC

  • Clinic/Center
  • Vicksburg, MS
National Provider Identifier
1205524261
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
QUAD INTERMED COMPANY LLC
Practice address
4204 Clay St
Vicksburg, MS 39183-3438
Phone
(601) 619-7717
NPI assigned
Apr 27, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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

Authorized official

Name
Ashley Buie
Title
Director
Phone
(601) 898-7530

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4204 Clay St
Vicksburg, MS 39183-3438

Mailing address

308 Corporate Dr
Ridgeland, MS 39157-8803
Phone (601) 898-7530

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230706000437 MS Part B Supplier - Clinic/Group Practice 6709245954 Receives reassigned benefits from 50 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pearl, MS; Brandon, MS; Yazoo City, MS; Vicksburg, MS; Ridgeland, MS; Richland, MS; Madison, MS; Laurel, MS…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Quad Intermed Company LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

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": "1682553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685664000000",
    "number": "1205524261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 CORPORATE DR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578803",
            "telephone_number": "601-898-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 CLAY ST",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391833438",
            "telephone_number": "601-619-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAD INTERMED COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-27",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A",
        "authorized_official_last_name": "BUIE",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-898-7530"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.