Family Care Medical Clinic, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R729086 Issued in MS

Legal business name

FAMILY CARE MEDICAL CLINIC, LLC

Doing business as

Family Care Medical Clinic

Practice address

109 Park Gate Ext
Tupelo, MS 38801-3038

Phone

(662) 840-4175

Fax

(662) 840-8279

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Sylvia O Blanchard, CFNPNPI 1770595084

Title

Ceo

Phone

(662) 840-4175

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Care Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 258996

Legal name

FAMILY CARE MEDICAL CLINIC, LLC

Doing business as

NA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 2, 2007

Last certification

Jul 20, 2022

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Apr 23, 2004 in MS

Enrollment address

109 Park Gate Ext
Tupelo, MS 38801-3038

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Sylvia Blanchard, CFNP

  • Family Nurse Practitioner
  • Tupelo, MS
  • NPI 1770595084

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Practitioners 2

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

• Sylvia Blanchard, CFNP

  • Family Nurse Practitioner
  • Tupelo, MS
  • NPI 1770595084
  Medicare reassignment NPD Authorized official
• Kristen Marie Loden, FNP-C

  • Family Nurse Practitioner
  • Tupelo, MS
  • NPI 1528522588
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437210457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 PARK GATE EXT",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013038",
            "telephone_number": "662-840-4175",
            "fax_number": "662-840-8279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 PARK GATE EXT",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013038",
            "telephone_number": "662-840-4175",
            "fax_number": "662-840-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-840-4175",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R729086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00124764",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bryan Christopher Fagan, M.D.
• Fair Park Counseling PLLC
• Hunter Chase Fairley
• Rachel Fairley
• Faith Christian Counseling, LLC
• Family First Homecare Inc Dba Visiting Angels of North Mississippi
• Brianna Far
• Paul Farabaugh, MD
• Alison Farley, PT
• Clarance Stephen Farmer II, MD

• Family Nurse Practitioner in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Family Nurse Practitioner 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.