Medical Foundation of South Ms

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

MEDICAL FOUNDATION OF SOUTH MS

Practice address

618 Blue Meadow Rd
Suite 20
Bay St Louis, MS 39520-2834

Phone

(228) 463-0824

Fax

(228) 463-0827

NPI assigned

Jun 21, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Randy Robinson

Title

Administrator

Phone

(228) 865-1453

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bay Plaza Medical Clinic Doing business as

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1477599280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 31ST AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012750",
            "telephone_number": "228-865-1453",
            "fax_number": "228-865-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 BLUE MEADOW RD",
            "address_2": "SUITE 20",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395202834",
            "telephone_number": "228-463-0824",
            "fax_number": "228-463-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL FOUNDATION OF SOUTH MS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "228-865-1453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02976571",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Plaza Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Dianne Martin, CRNA
• Dovie Lou Mayes, CRNA
• Sean McDaniel, PCMHT
• Mary Gray McDunnah, RPH
• Denisha V McNair, PCMHT
• Teresa C Meece, FNP-C
• Memorial Hospital at Gulfport
• Memorial Hospital at Gulfport
• Memorial Hospital at Gulfport
• Memorial Hospital at Gulfport

• Pediatrics Physician in Bay St Louis, MS
• Providers in Bay St Louis, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; 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.