L.C. Tennin, Jr M.D., P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

L.C. TENNIN, JR M.D., P.A.

Practice address

122 E Academy St
Canton, MS 39046-4502

Phone

(601) 859-8992

Fax

(601) 859-5573

NPI assigned

Apr 17, 2009

Last updated

Apr 27, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. LC Tennin Jr.NPI 1275543597

Title

Administrative President

Phone

(601) 214-5998

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598908774. Details of each certification follow.

• CCN 253814 Rural health clinic · Active · Details

Rural health clinic certification: CCN 253814

Legal name

L.C. TENNIN, JR M.D., P.A.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 4, 2009

Last certification

Jan 24, 2023

Ownership / control type

1A

Organization structure

CorporationProprietary

Incorporated

May 8, 2009 in MS

Enrollment address

122 East Academy Street
Canton, MS 39046-8406

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.

• L C Tennin Jr., MD

  • Internal Medicine Physician
  • Canton, MS
  • NPI 1275543597

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

  CMS ownership

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.

• L C Tennin Jr., MD

  • Internal Medicine Physician
  • Canton, MS
  • NPI 1275543597
  NPD Authorized official

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556323200000",
    "number": "1598908774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 647",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390460647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E ACADEMY ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390464502",
            "telephone_number": "601-859-8992",
            "fax_number": "601-859-5573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L.C. TENNIN, JR M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2019-04-27",
        "status": "A",
        "authorized_official_last_name": "TENNIN",
        "authorized_official_first_name": "LC",
        "authorized_official_title_or_position": "ADMINISTRATIVE PRESIDENT",
        "authorized_official_telephone_number": "601-214-5998",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Canton, MS
• Providers in Canton, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2019; 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.