Heritage Obstetrics & Gynecolgy Clinic of NM PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

207V00000X Issued in MS

Legal business name

HERITAGE OBSTETRICS & GYNECOLGY CLINIC OF NM PA

Practice address

606 Brunson Dr
Tupelo, MS 38801-4947

Phone

(662) 840-4010

Fax

(662) 840-9038

NPI assigned

Aug 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gregg A Willis, MD

Title

President

Phone

(662) 840-4010

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Leody Caibigan Bautista, M.D.

  • Obstetrics & Gynecology Physician
  • Tupelo, MS
  • NPI 1427286236
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407867807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 BRUNSON DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014947",
            "telephone_number": "662-840-4010",
            "fax_number": "662-840-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 BRUNSON DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014947",
            "telephone_number": "662-840-4010",
            "fax_number": "662-840-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE OBSTETRICS & GYNECOLGY CLINIC OF NM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-840-4010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "207V00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05453772",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Wiley Henshaw, PA-C
• Ashley Sprayberry Henson, FNP-C
• Grace Stonecypher Henson
• Mary T Henson
• William Chase Henson, M.D.
• Jessica May Hernandez
• Herndon Chiropractic LLC
• Ron Herndon, D.C.
• Audrey Herren
• Alyssa Herring

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.