NPIMap

Organization Active NPI

Magnolia Regional Community Care Clinic

  • Internal Medicine Physician
  • Corinth, MS
National Provider Identifier
1639338577
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MAGNOLIA REGIONAL COMMUNITY CARE CLINIC
Practice address
703 Alcom Drive
109
Corinth, MS 38834-9302
Phone
(662) 293-1680
Fax
(662) 293-1595
NPI assigned
Jun 5, 2008
Organization subpart
Yes
Parent organization
MAGNOLIA REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Authorized official

Name
Mr. Howard D. Nelson
Title
VP Physicain Services
Phone
(662) 293-7618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

703 Alcom Drive
109
Corinth, MS 38834-9302

Mailing address

401 Alcorn Dr Ste 2C
Corinth, MS 38834-9073
Phone (662) 293-7618

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mrccc@magnolia.medalliesdirect.net Direct

National Provider Directory

National Provider Directory
Part of
Magnolia Hospital Ekg

Interoperability endpoints

  • Direct secure messaging: mrccc@magnolia.medalliesdirect.net

NPI Registry JSON

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1639338577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 ALCORN DR STE 2C",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349073",
            "telephone_number": "662-293-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 ALCOM DRIVE",
            "address_2": "109",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388349302",
            "telephone_number": "662-293-1680",
            "fax_number": "662-293-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA REGIONAL COMMUNITY CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA REGIONAL HEALTH CENTER",
        "enumeration_date": "2008-06-05",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "VP PHYSICAIN SERVICES",
        "authorized_official_telephone_number": "662-293-7618",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mrccc@magnolia.medalliesdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "202 Alcorn Dr",
            "city": "Corinth",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388349701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corinth, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.