Organization Active NPI

NCC

  • Clinic/Center
  • Jackson, MS
National Provider Identifier
1376195727
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NCC
Practice address
2416 Southerland Drive
Jackson, MS 39216-3762
Phone
(601) 683-3200
NPI assigned
Jul 15, 2019
Last updated
Jul 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Authorized official

Name
J. Nolan
Title
Office Manager
Phone
(601) 376-9322

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

2416 Southerland Drive
Jackson, MS 39216-3762

Mailing address

2416 Southerland Drive
Jackson, MS 39216
Phone (601) 376-9322

National Provider Directory

National Provider Directory

Locations

1435 Grand Ave
Yazoo City, MS 39194
Phone (662) 532-2399

NPI Registry JSON

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

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625097600000",
    "number": "1376195727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 SOUTHERLAND DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-376-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 SOUTHERLAND DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392163762",
            "telephone_number": "601-683-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NCC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-15",
        "last_updated": "2021-07-01",
        "certification_date": "2021-06-12",
        "status": "A",
        "authorized_official_last_name": "NOLAN",
        "authorized_official_first_name": "J.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "601-376-9322"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; 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.