NPIMap

Organization Active NPI

Surgery Clinic of Tupelo PA

  • Surgery Physician
  • Tupelo, MS
National Provider Identifier
1346211539
Registry record updated Dec 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGERY CLINIC OF TUPELO PA
Practice address
499 Gloster Creek VLG Ste S1
Tupelo, MS 38801-4708
Phone
(662) 377-6470
Fax
(662) 377-6475
NPI assigned
Jan 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2018

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

Authorized official

Name
Terecia Spain
Title
Clinic Administrator
Phone
(662) 377-6472

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

499 Gloster Creek VLG Ste S1
Tupelo, MS 38801-4708

Mailing address

454 E President Ave
Tupelo, MS 38801-5501
Phone (662) 377-6470

Other identifiers 1

IdentifierTypeStateIssuer
09013129MedicaidMS

National Provider Directory

National Provider Directory

Locations

499 Gloster Creek Vlg
Ste S1
Tupelo, MS 38801
Phone (662) 377-6470

454 E President Ave
Tupelo, MS 38801

499 Gloster Creek Vlg
Ste S2
Tupelo, MS 38801
Phone (662) 377-6331

Practitioners & affiliated clinicians

Practitioners 5

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": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544745600000",
    "number": "1346211539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 E PRESIDENT AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015501",
            "telephone_number": "662-377-6470",
            "fax_number": "662-377-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG STE S1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014708",
            "telephone_number": "662-377-6470",
            "fax_number": "662-377-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CLINIC OF TUPELO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2018-12-14",
        "status": "A",
        "authorized_official_last_name": "SPAIN",
        "authorized_official_first_name": "TERECIA",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "662-377-6472"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013129",
            "state": "MS"
        }
    ],
    "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 Dec 14, 2018; 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.