Southern Pines Family Medical

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHERN PINES FAMILY MEDICAL

Doing business as

Southern Pines Family Medical Center

Practice address

64629 Highway 41
Pearl River, LA 70452-3611

Phone

(985) 863-7100

NPI assigned

Oct 5, 2006

Last updated

Jun 8, 2011By 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

Dr. Glenn Butt, M D

Title

Member

Phone

(985) 863-7100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southern Pines Family Medical Center Doing business as

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1245326149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1659",
            "city": "PEARL RIVER",
            "state": "LA",
            "postal_code": "704521659",
            "telephone_number": "985-863-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64629 HIGHWAY 41",
            "city": "PEARL RIVER",
            "state": "LA",
            "postal_code": "704523611",
            "telephone_number": "985-863-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES FAMILY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "BUTT",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "985-863-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1439959",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pines Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Pearl River, LA
• Providers in Pearl River, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.