NPIMap

Organization Active NPI

East Main Family Medical Clinic LLC

  • Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1285072058
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
EAST MAIN FAMILY MEDICAL CLINIC LLC
Practice address
1424 E Main St
Tupelo, MS 38804-2956
Phone
(662) 842-4877
NPI assigned
Jun 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Rodney Rodgers, FNP
Title
Owner/Nurse Practitioner
Phone
(662) 350-3550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1424 E Main St
Tupelo, MS 38804-2956

Mailing address

1424 E Main St
Tupelo, MS 38804-2956
Phone (662) 350-3550

Other practice location 1

5024 Raymond Ave
Tupelo, MS 38801-8671
Phone (662) 432-0782

National Provider Directory

National Provider Directory

Locations

1464 E Main St
Tupelo, MS 38804

Practitioners & affiliated clinicians

Practitioners 4

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": "1371081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1285072058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 E MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042956",
            "telephone_number": "662-350-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 E MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042956",
            "telephone_number": "662-842-4877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5024 Raymond Ave",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388018671",
            "country_code": "US",
            "telephone_number": "662-432-0782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST MAIN FAMILY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-13",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "OWNER/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "662-350-3550",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Sep 8, 2020; 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.