Family Cancer Center, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

19652 Issued in TN

Legal business name

FAMILY CANCER CENTER, PLLC

Practice address

391 Southcrest Cir
Suite 101
Southaven, MS 38671-4848

Phone

(662) 349-0755

Fax

(662) 349-0356

NPI assigned

Jul 31, 2006

Organization subpart

No

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

Authorized official

Name

William K Walsh, M.D.

Title

Managing Physician

Phone

(901) 685-5655

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1407862899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5111",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381015111",
            "telephone_number": "901-685-5655",
            "fax_number": "901-685-2590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 SOUTHCREST CIR",
            "address_2": "SUITE 101",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714848",
            "telephone_number": "662-349-0755",
            "fax_number": "662-349-0356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CANCER CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "901-685-5655",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "19652",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MS",
            "license": "18137",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090015910",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0090015910",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR",
            "identifier": "CK3826",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Golnaz Fakour Bayat Shirazi, MD
• Family Ear Nose & Throat Care
• Family Medical Clinic of North Ms Inc
• Brooke Farmer
• Destiny Farmer, DPT
• Yen Pham Farmer, FNP-BC

• Specialist in Southaven, MS
• Providers in Southaven, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.