NPIMap

Organization Active NPI

Golden Triangle Urgent Care LLC

  • Rural Health Clinic/Center
  • Starkville, MS
National Provider Identifier
1346592045
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GOLDEN TRIANGLE URGENT CARE LLC
Practice address
500 Russell St Ste 3
Starkville, MS 39759-5411
Phone
(662) 324-2244
Fax
(662) 324-2295
NPI assigned
Oct 5, 2012
Last updated
Dec 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Authorized official

Name
Rudy Blank
Title
Cfo
Phone
(615) 988-2005

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Urgent Care Clinic/Center 261QU0200X
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

500 Russell St Ste 3
Starkville, MS 39759-5411

Mailing address

30 Burton Hills Blvd
Suite 175
Nashville, TN 37215-6403
Phone (615) 988-2009

Other identifiers 1

IdentifierTypeStateIssuer
04351854MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121025000818 MS Part B Supplier - Clinic/Group Practice 7315197498 Receives reassigned benefits from 39 practitioners
Practice locations: West Point, MS; Starkville, MS; Saltillo, MS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1503 Highway 45 N
Columbus, MS 39705
Phone (601) 328-9623

500 Russell St
Ste 3
Starkville, MS 39759
Phone (662) 324-2244

7474 Highway 45 Alternate
West Point, MS 39773
Phone (662) 494-5863

Practitioners & affiliated clinicians

Practitioners 42

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.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1346592045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BURTON HILLS BLVD",
            "address_2": "SUITE 175",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156403",
            "telephone_number": "615-988-2009",
            "fax_number": "615-250-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 RUSSELL ST STE 3",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397595411",
            "telephone_number": "662-324-2244",
            "fax_number": "662-324-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN TRIANGLE URGENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2022-12-02",
        "certification_date": "2022-10-24",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "RUDY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "615-988-2005"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04351854",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Starkville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.