NPIMap

Organization Active NPI

Alcorn State University

  • Health Service Clinic/Center
  • Natchez, MS
National Provider Identifier
1285776328
Registry record updated Dec 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
ALCORN STATE UNIVERSITY
Practice address
15 Campus Dr
Natchez, MS 39120-5364
Phone
(601) 304-4375
Fax
(601) 304-4355
NPI assigned
Feb 13, 2007
Organization subpart
Yes
Parent organization
ALCORN STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2007

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

Authorized official

Name
Dr. Linda Godley
Title
Director
Phone
(601) 304-4375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

15 Campus Dr
Natchez, MS 39120-5364

Mailing address

15 Campus Dr
Natchez, MS 39120-5364
Phone (601) 304-4334

Other names 1

  • ASU FAMILY CLINIC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0666058Alcorn State University Family Clinic15 Campus Drive, Natchez, MS 39120Certificate of waiverJul 23, 2028

National Provider Directory

National Provider Directory
Part of
Alcorn State University

Locations

15 Campus Dr
Natchez, MS 39120
Phone (601) 304-4334

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1285776328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CAMPUS DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391205364",
            "telephone_number": "601-304-4334",
            "fax_number": "601-304-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CAMPUS DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391205364",
            "telephone_number": "601-304-4375",
            "fax_number": "601-304-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALCORN STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALCORN STATE UNIVERSITY",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "GODLEY",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-304-4375",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASU FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Natchez, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.