Archon Med LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

ARCHON MED LLC

Practice address

5090 Gautier Vancleave Rd
Gautier, MS 39553-4803

Phone

(228) 522-6700

NPI assigned

Apr 5, 2021

Last updated

Apr 5, 2021By 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

Stephen Nunenmacher, MDNPI 1487705042

Title

Owner

Phone

(228) 233-4404

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 1

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.

• Stephen Nunenmacher

  • Emergency Medicine Physician
  • Pascagoula, MS
  • NPI 1487705042
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1285213546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 N 4TH ST",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395648534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5090 GAUTIER VANCLEAVE RD",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395534803",
            "telephone_number": "228-522-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHON MED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-05",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "NUNENMACHER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-233-4404",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Kristen Allen
• Amedisys Mississippi, LLC (Amedisys Home Health of Pascagoula)
• Venus Lacy Amezcua
• Diane Anderson, M.S.
• Sheila Elaine Andrews, MSW
• Ark Medical PLLC
• Helen Ann Ashbee, BA
• Dianne Aultman, MS
• Myrtis Austin
• Dorothy Averitt, MS

• Emergency Medicine Physician in Gautier, MS
• Providers in Gautier, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.