Medical Foundation of South Ms

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

MEDICAL FOUNDATION OF SOUTH MS

Doing business as

Children's Clinic

Practice address

20091 Pineville Rd
Long Beach, MS 39560-3208

Phone

(228) 868-3684

Fax

(228) 868-3795

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Randy Robinson

Title

Administrator

Phone

(228) 865-1453

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Children's Clinic Doing business as

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1265451231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 31ST AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012750",
            "telephone_number": "228-865-1453",
            "fax_number": "228-865-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20091 PINEVILLE RD",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395603208",
            "telephone_number": "228-868-3684",
            "fax_number": "228-868-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL FOUNDATION OF SOUTH MS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "228-865-1453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014471",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thea Rochelle Martin, LMT,
• Max M Edrington Optometrist PA
• Beth K McGee, LPN
• Emily McDermott McGinity, DPT
• Medical Foundation of South Ms (Long Beach Walk-In Clinic)
• Medical Foundation of South Ms (Beatline Internal Medicine)
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)
• Memorial Hospital at Gulfport (Physicians Clinic at MHG)
• Memorial Hospital at Gulfport

• Pediatrics Physician in Long Beach, MS
• Providers in Long Beach, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.