Active NPI
Bude Clinic Lab
- Clinical Medical Laboratory
- Bude, MS
National Provider Identifier
1235216276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- BUDE CLINIC LAB
- Practice address
- 136 Main St N
Bude, MS 39630 - Phone
- (601) 384-2394
- Fax
- (601) 384-4199
- NPI assigned
- Nov 1, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mary K Larkin
- Title
- Office Manager
- Phone
- (601) 384-2394
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | NU | Primary |
Addresses
Primary practice location
136 Main St N
Bude, MS 39630
Mailing address
PO Box 445
Bude, MS 39630
Phone (601) 384-2394
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00116640 | Medicaid | MS |
National Provider Directory
National Provider DirectoryPractitioners & 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.
-
- Family Nurse Practitioner
- Bude, MS
- NPI 1477633253
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1235216276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 445",
"city": "BUDE",
"state": "MS",
"postal_code": "39630",
"telephone_number": "601-384-2394",
"fax_number": "601-384-2395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 MAIN ST N",
"city": "BUDE",
"state": "MS",
"postal_code": "39630",
"telephone_number": "601-384-2394",
"fax_number": "601-384-4199"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BUDE CLINIC LAB",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-01",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "LARKIN",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "601-384-2394"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00116640",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bude, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.