Glendora Clinic

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R767376 Issued in MS

Legal business name

GLENDORA CLINIC

Practice address

44 Westbrooks Ave
Glendora, MS 38928

Phone

(662) 375-8878

NPI assigned

Jul 14, 2008

Last updated

Jul 14, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

TUTWILER CLINICAs reported in NPPES

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

Authorized official

Name

Anne E Brooks, DO

Title

Medical Director

Phone

(662) 345-2334

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Tutwiler Clinic Inc

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Tutwiler Clinic Inc

  • Family Medicine Physician
  • Tutwiler, MS
  • NPI 1811008261
  NPPES parent name

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1316101843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "address_2": "CORNER OF GIBSON AND WESTBROOKS AVE",
            "city": "GLENDORA",
            "state": "MS",
            "postal_code": "389280189",
            "telephone_number": "662-375-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 WESTBROOKS AVE",
            "city": "GLENDORA",
            "state": "MS",
            "postal_code": "38928",
            "telephone_number": "662-375-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDORA CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TUTWILER CLINIC",
        "enumeration_date": "2008-07-14",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL  DIRECTOR",
        "authorized_official_telephone_number": "662-345-2334",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R767376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014072",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.