Organization Active NPI

Trace Medical Clinic, PLLC

  • Family Medicine Physician
  • Kosciusko, MS
National Provider Identifier
1376846469
Registry record updated Dec 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRACE MEDICAL CLINIC, PLLC
Practice address
530 Veterans Memorial Dr
Kosciusko, MS 39090-3858
Phone
(662) 289-9155
Fax
(662) 289-7752
NPI assigned
Dec 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2010

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

Authorized official

Name
Dr. Robert G Browning, MD
Title
President
Phone
(662) 289-9155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

530 Veterans Memorial Dr
Kosciusko, MS 39090-3858

Mailing address

530 Veterans Memorial Dr
Kosciusko, MS 39090-3858
Phone (662) 289-9155

National Provider Directory

National Provider Directory

Locations

530 Veterans Memorial Dr
Kosciusko, MS 39090
Phone (662) 289-9155

NPI Registry JSON

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

{
    "created_epoch": "1291939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1376846469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 VETERANS MEMORIAL DR",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903858",
            "telephone_number": "662-289-9155",
            "fax_number": "662-289-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 VETERANS MEMORIAL DR",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903858",
            "telephone_number": "662-289-9155",
            "fax_number": "662-289-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACE MEDICAL CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-10",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "BROWNING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-289-9155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2010; 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.