NPIMap

Organization Active NPI

Forest Family Practice Clinic PA

  • Family Medicine Physician
  • Forest, MS
National Provider Identifier
1235119181
Registry record updated Oct 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
05638 Issued in MS
Legal business name
FOREST FAMILY PRACTICE CLINIC PA
Practice address
1 Medical LN
Forest, MS 39074-4039
Phone
(601) 469-4861
Fax
(601) 469-4828
NPI assigned
Jan 18, 2006
Last updated
Oct 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2008

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

Authorized official

Name
John Paul Lee, M.D.NPI 1992806699
Title
President
Phone
(601) 469-4861

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 05638 MS Primary

Addresses

Primary practice location

1 Medical LN
Forest, MS 39074-4039

Mailing address

PO Box 600
Forest, MS 39074-0600
Phone (601) 469-4861

Other identifiers 1

IdentifierTypeStateIssuer
09014143MedicaidMS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224633600000",
    "number": "1235119181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390740600",
            "telephone_number": "601-469-4861",
            "fax_number": "601-469-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL LN",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744039",
            "telephone_number": "601-469-4861",
            "fax_number": "601-469-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST FAMILY PRACTICE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2008-10-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-469-4861",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "05638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014143",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; 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.