Organization Active NPI

Histology Cytology Technical Lab of North Mississippi

  • Anatomic Pathology & Clinical Pathology Physician
  • Oxford, MS
National Provider Identifier
1578717674
Registry record updated Dec 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
11854 Issued in MS
Legal business name
HISTOLOGY CYTOLOGY TECHNICAL LAB OF NORTH MISSISSIPPI
Practice address
2301 S Lamar Blvd
Oxford, MS 38655-5373
Phone
(662) 232-8121
Fax
(662) 236-5236
NPI assigned
Nov 17, 2008
Last updated
Dec 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2008

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

Authorized official

Name
Dr. John P Fullenwider, M.D.
Title
Sole Proprietor
Phone
(800) 362-0858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 11854 MS Primary

Addresses

Primary practice location

2301 S Lamar Blvd
Oxford, MS 38655-5373

Mailing address

PO Box 428
Oxford, MS 38655-0428
Phone (662) 232-8121

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1578717674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386550428",
            "telephone_number": "662-232-8121",
            "fax_number": "662-236-5236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 S LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555373",
            "telephone_number": "662-232-8121",
            "fax_number": "662-236-5236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HISTOLOGY CYTOLOGY TECHNICAL LAB OF NORTH MISSISSIPPI",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "FULLENWIDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "800-362-0858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MS",
            "license": "11854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxford, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.