NPIMap

Organization Active NPI

Friendship Medical Clinic, LLC

  • Nurse Practitioner
  • Ecru, MS
National Provider Identifier
1275586273
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
FRIENDSHIP MEDICAL CLINIC, LLC
Practice address
5129 Highway 15 N
Ecru, MS 38841-9407
Phone
(662) 488-8799
Fax
(772) 382-7966
NPI assigned
May 19, 2006
Last updated
Sep 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Authorized official

Name
Mr. Bobby Ken Nowlin
Title
Owner
Phone
(662) 489-3333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

5129 Highway 15 N
Ecru, MS 38841-9407

Mailing address

5129 Highway 15 N
Ecru, MS 38841-9407
Phone (662) 488-8799

Other identifiers 1

IdentifierTypeStateIssuer
04170317MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060918000250 MS Part B Supplier - Clinic/Group Practice 0648275024 Receives reassigned benefits from 14 practitioners
Practice locations: Ecru, MS; New Albany, MS; Tupelo, MS

National Provider Directory

National Provider Directory

Locations

5129 Highway 15 N
Ecru, MS 38841
Phone (662) 488-8799

5482 Highway 15 N
Ecru, MS 38841
Phone (662) 256-9730

509 State Highway 15 S
New Albany, MS 38652
Phone (662) 534-4330

4127 W Main St
Tupelo, MS 38801
Phone (662) 269-3191

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGAACA

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1275586273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5129 HIGHWAY 15 N",
            "city": "ECRU",
            "state": "MS",
            "postal_code": "388419407",
            "telephone_number": "662-488-8799",
            "fax_number": "772-382-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5129 HIGHWAY 15 N",
            "city": "ECRU",
            "state": "MS",
            "postal_code": "388419407",
            "telephone_number": "662-488-8799",
            "fax_number": "772-382-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDSHIP MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "NOWLIN",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "KEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-489-3333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04170317",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ecru, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.