NPIMap

Organization Active NPI

Gilmore Primary Care

  • Internal Medicine Physician
  • Amory, MS
National Provider Identifier
1306069612
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GILMORE PRIMARY CARE
Practice address
900 Earl Frye Blvd Ste C
Amory, MS 38821-5507
Phone
(662) 256-6227
NPI assigned
Apr 11, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Chris Dedeaux
Title
Clinic Administrator
Phone
(662) 256-7112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

900 Earl Frye Blvd Ste C
Amory, MS 38821-5507

Mailing address

123 Main St N
Amory, MS 38821-3416

National Provider Directory

National Provider Directory
Tax ID family
Detroit Fam Medical Clin17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

900 Earl Frye Blvd
Ste C
Amory, MS 38821
Phone (662) 256-6227

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306069612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 MAIN ST N",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388213416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 EARL FRYE BLVD STE C",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388215507",
            "telephone_number": "662-256-6227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILMORE PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEDEAUX",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "662-256-7112"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amory, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.