Shannon Family Medical Clinic, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

R819576 Issued in MS

Legal business name

SHANNON FAMILY MEDICAL CLINIC, LLC

Practice address

219 Broad St
Shannon, MS 38868

Phone

(662) 995-2201

Fax

(662) 995-2202

NPI assigned

Mar 13, 2008

Organization subpart

No

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

Authorized official

Name

Norris N Doss, FNP

Title

Owner

Phone

(662) 995-2201

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1568633964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 BROAD ST",
            "city": "SHANNON",
            "state": "MS",
            "postal_code": "388689301",
            "telephone_number": "662-995-2201",
            "fax_number": "662-995-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 BROAD ST",
            "city": "SHANNON",
            "state": "MS",
            "postal_code": "38868",
            "telephone_number": "662-995-2201",
            "fax_number": "662-995-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "DOSS",
        "authorized_official_first_name": "NORRIS",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-995-2201",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "R819576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05188209",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Norris Doss, NP
• Bethany Ann Ellis, PTA
• Kristi Herndon Lindley, LPC, NBCC
• Kantina McGaughy
• Prime Med Service Inc
• Eurieka Denise Shumpert, NURSE PRACTITIONER
• Janna Yvonne Stafford, CCC-SLP
• Tru-King Transportation

• Rural Health Clinic/Center in Shannon, MS
• Providers in Shannon, MS by specialty
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.