NPIMap

Organization Active NPI

University Family Medicine Associates, PLLC

  • Clinic/Center
  • Jackson, MS
National Provider Identifier
1396846648
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
UNIVERSITY FAMILY MEDICINE ASSOCIATES, PLLC
Practice address
878 Lakeland Drive
Jackson, MS 39216
Phone
(601) 984-6800
Fax
(601) 984-6812
NPI assigned
Sep 26, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Diane K Beebe, M.D.NPI 1881795235
Title
Professor/Interim Chairman
Phone
(601) 984-5410

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MS Primary

Addresses

Primary practice location

878 Lakeland Drive
Jackson, MS 39216

Mailing address

P.O Box 4999
Jackson, MS 39296
Phone (601) 984-5410

Other identifiers 2

IdentifierTypeStateIssuer
09014130MedicaidMS
09014106MedicaidMS

National Provider Directory

National Provider Directory

Locations

1920 Chadwick Dr
Jackson, MS 39204
Phone (601) 372-2123

878 Lakeland Dr
Jackson, MS 39216
Phone (601) 984-6800

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1396846648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX 4999",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39296",
            "telephone_number": "601-984-5410",
            "fax_number": "601-815-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 LAKELAND DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-984-6800",
            "fax_number": "601-984-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY FAMILY MEDICINE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BEEBE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PROFESSOR/INTERIM CHAIRMAN",
        "authorized_official_telephone_number": "601-984-5410",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014130",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014106",
            "state": "MS"
        }
    ],
    "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 21, 2022; 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.