NPIMap

Organization Active NPI

Comprehensive Family Medical Center, Inc.

  • Family Nurse Practitioner
  • Horn Lake, MS
National Provider Identifier
1396014395
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A810353 Issued in MS
Legal business name
COMPREHENSIVE FAMILY MEDICAL CENTER, INC.
Practice address
3040 Goodman Rd W
Horn Lake, MS 38637-1189
Phone
(662) 280-3428
Fax
(662) 280-1736
NPI assigned
Dec 20, 2011
Last updated
Dec 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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

Authorized official

Name
Mr. Robert L Smith, NP-C
Title
Owner
Phone
(662) 280-3428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A810353 MS Primary

Addresses

Primary practice location

3040 Goodman Rd W
Horn Lake, MS 38637-1189

Mailing address

3040 Goodman Rd W
Horn Lake, MS 38637-1189
Phone (662) 280-3428

Other identifiers 1

IdentifierTypeStateIssuer
1134450307OtherMSCOMMERCIAL INSURANCE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1396014395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 GOODMAN RD W",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371189",
            "telephone_number": "662-280-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 GOODMAN RD W",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371189",
            "telephone_number": "662-280-3428",
            "fax_number": "662-280-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-280-3428",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "A810353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "1134450307",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Horn Lake, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.