NPIMap

Organization Active NPI

Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Bogalusa, LA
National Provider Identifier
1457781486
Registry record updated May 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CARE CLINIC, INC
Practice address
100 Red Cross PL
Bogalusa, LA 70427-3732
Phone
(800) 508-7481
Fax
(601) 825-8130
NPI assigned
Nov 12, 2013
Last updated
May 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2024

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

Authorized official

Name
Margaret A Gray, DPA
Title
President and Ceo
Phone
(601) 825-7280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

100 Red Cross PL
Bogalusa, LA 70427-3732

Mailing address

PO Box 24116
Jackson, MS 39225-4116
Phone (601) 825-7280

Other identifiers 1

IdentifierTypeStateIssuer
02359533MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140527001225 LA Part A Provider - Federally Qualified Health Center (FQHC) 5395656946 Practice locations: Bogalusa, LA
O20190111003016 LA Part B Supplier - Clinic/Group Practice 5395656946 Receives reassigned benefits from 2 practitioners
Practice locations: Bogalusa, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457781486. Details of each certification follow.

Federally qualified health center certification: CCN 191914

Legal name
FAMILY HEALTH CARE CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2014
Last certification
May 23, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1996 in MS
Enrollment address
100 Red Cross PL
Bogalusa, LA 70427-3732

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2071188Family Health Care Clinic Inc-Bogalusa100 Red Cross Place, Bogalusa, LA 70427Provider-performed microscopyJan 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Family Health Care Clinic Inc36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Joan Derryberry Individual Corporate DirectorBoard Member Feb 1, 2016
Margaret a Gray Individual Corporate OfficerPresident Jul 1, 1980
W-2 Managing EmployeeChief Executive Officer Jul 1, 1980
Kaitlynn Mixon-Smith Individual Corporate DirectorBoard Member Feb 1, 2016
Charles Hatten Individual Corporate OfficerBoard Member Jan 1, 2003
Michael Howard Individual Corporate OfficerBoard Member Jan 1, 2006
Helen Johnson Individual Corporate OfficerBoard Members Jan 1, 2004
Louise Patterson Individual Corporate OfficerBoard Member Feb 1, 2003
Moses Johnson Individual Corporate DirectorBoard Member Feb 1, 2016
Annie Posey Individual Corporate OfficerBoard Member Feb 23, 2010
Carolyn Hartzog Individual Corporate DirectorBoard Member Feb 1, 2014
Lydia Gonzalez-Seals Individual Corporate DirectorBoard Member Feb 1, 2014
Cindy Bryan Individual Corporate OfficerBoard Member Feb 1, 2006
Eddie Thames Individual Corporate OfficerBoard Member Jun 19, 2009

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Health Care Clinic IncRussellville, AL, CCN 011965 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncMuscle Shoals, AL, CCN 011970 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncDecatur, AL, CCN 011967 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncTown Creek, AL, CCN 011966 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncFlorence, AL, CCN 011969 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncRogersville, AL, CCN 011971 Federally qualified health center Operational/Managerial Control Aug 1, 2009

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714694400000",
    "number": "1457781486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24116",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392254116",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RED CROSS PL",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704273732",
            "telephone_number": "800-508-7481",
            "fax_number": "601-825-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "601-825-7280",
        "authorized_official_credential": "DPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02359533",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bogalusa, LA

Sources for this page

Verify at the official NPI Registry.