NPIMap

Organization Active NPI

Southland Wellness PLLC

  • Anesthesiology Physician
  • Olive Branch, MS
National Provider Identifier
1609586346
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SOUTHLAND WELLNESS PLLC
Practice address
6810 Crumpler Blvd Ste 100
Olive Branch, MS 38654-1934
Phone
(662) 892-8728
NPI assigned
Dec 5, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Authorized official

Name
Lindsay Pace, RNNPI 1083312433
Title
Owner
Phone
(901) 281-9387

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WI0500X
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Infusion Therapy Clinic/Center 261QI0500X

Addresses

Primary practice location

6810 Crumpler Blvd Ste 100
Olive Branch, MS 38654-1934

Mailing address

6810 Crumpler Blvd Ste 100
Olive Branch, MS 38654-1934
Phone (662) 892-8728

Other identifiers 1

IdentifierTypeStateIssuer
3836655MedicaidTN

Other names 1

  • Southland Wellness PLLC Doing business as

National Provider Directory

National Provider Directory

Locations

6810 Crumpler Blvd
Ste 100
Olive Branch, MS 38654
Phone (662) 892-8728

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670198400000",
    "number": "1609586346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 CRUMPLER BLVD STE 100",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541934",
            "telephone_number": "662-892-8728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 CRUMPLER BLVD STE 100",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541934",
            "telephone_number": "662-892-8728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-05",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-04",
        "status": "A",
        "authorized_official_last_name": "PACE",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-281-9387",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163WI0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3836655",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southland Wellness PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; 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.