Moss Street Medical Clinic Inc

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

A10226 Issued in LA

Legal business name

MOSS STREET MEDICAL CLINIC INC

Practice address

1417 Moss St
Lafayette, LA 70501-3654

Phone

(337) 232-3371

Fax

(337) 232-3511

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Rickie Edward Johnson, PANPI 1982681292

Title

Owner

Phone

(337) 232-3371

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rickie E. Johnson, PA

  • Physician Assistant
  • Hill Air Force Base, UT
  • NPI 1982681292
  NPD Authorized official

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417085192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 MOSS ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705013654",
            "telephone_number": "337-232-3371",
            "fax_number": "337-232-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 MOSS ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705013654",
            "telephone_number": "337-232-3371",
            "fax_number": "337-232-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSS STREET MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RICKIE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-232-3371",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "A10226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1448397",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tianna M Morton, MD
• Francis J Morvant, D.C.
• Mary Katherine Moses, MS, RD
• Willard Warren Mosier Jr., M.D.
• Moss Street Kid Med LLC
• Samuel R, Moss, DDS
• Mother'S Promise
• Motherbirth, LLC
• Desiree Moton
• Terrence J Motte

• Medical Physician Assistant in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Medical Physician Assistant in Louisiana

• 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.