Desoto Family Medical Practice, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DESOTO FAMILY MEDICAL PRACTICE, P.C.

Practice address

7163 Goodman Rd
Olive Branch, MS 38654-1904

Phone

(662) 895-3700

Fax

(662) 895-4886

NPI assigned

Aug 12, 2006

Last updated

Nov 19, 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

Mrs. Karen M Tate

Title

Secretary

Phone

(662) 895-3700

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321660800000",
    "number": "1255343273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7163 GOODMAN RD",
            "address_2": "P. O. BOX 518",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541904",
            "telephone_number": "662-895-3700",
            "fax_number": "662-895-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7163 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541904",
            "telephone_number": "662-895-3700",
            "fax_number": "662-895-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO FAMILY MEDICAL PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2011-11-19",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "662-895-3700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDENTIFICATION NUMBER",
            "identifier": "512G700011",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Petzinger Deshazo, D.O.
• Design Your Wellness, LLC
• Desoto County Senior Care, LLC (Visiting Angels)
• Desoto Diagnostic Imaging, LLC (Methodist Diagnostic Center, LLC)
• Desoto Ear, Nose &Throat
• Desoto Primary Care Clinic, PLLC
• Desoto Transportation Services LLC
• Desutter Chiropractic Clinic, Inc.
• John Henry Desutter, D.C.
• Candace Fields Diamond, OTR/L

• Family Medicine Physician in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.