Organization Active NPI

Tupelo Orthopedic Clinic PA

  • Orthopaedic Surgery Physician
  • Tupelo, MS
National Provider Identifier
1245258193
Registry record updated Aug 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
TUPELO ORTHOPEDIC CLINIC PA
Practice address
808 Garfield St
Tupelo, MS 38801-5749
Phone
(662) 844-5330
Fax
(662) 841-2962
NPI assigned
Jul 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2012

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

Authorized official

Name
Mrs. Rhonda Black
Title
Insurance Clerk/Coder
Phone
(662) 844-5330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

808 Garfield St
Tupelo, MS 38801-5749

Mailing address

PO Box 1506
Tupelo, MS 38802-1506
Phone (662) 844-5330

Other identifiers 1

IdentifierTypeStateIssuer
9011365MedicaidMS

National Provider Directory

National Provider Directory

Locations

450S Eason Blvd
Tupelo, MS 38804
Phone (601) 844-5330

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1245258193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1506",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388021506",
            "telephone_number": "662-844-5330",
            "fax_number": "662-841-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 GARFIELD ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015749",
            "telephone_number": "662-844-5330",
            "fax_number": "662-841-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUPELO ORTHOPEDIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "INSURANCE CLERK/CODER",
        "authorized_official_telephone_number": "662-844-5330",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9011365",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.