Misissippi Providence Healthcare Services, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MISISSIPPI PROVIDENCE HEALTHCARE SERVICES, INC.

Practice address

5907 Highway 90
Moss Point, MS 39563-6536

Phone

(228) 769-2611

Fax

(228) 762-1638

NPI assigned

Sep 13, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Clark P. Christianson

Title

President

Phone

(251) 631-3574

Specialties & licenses 1

Addresses

Tax ID family

Misissippi Providence Healthcare Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mississippi Providence Healthcare Services Inc.

  • Family Medicine Physician
  • Mobile, AL
  • NPI 1821340407
  NPD tax ID

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

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1639429970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850489",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366850489",
            "telephone_number": "251-342-3949",
            "fax_number": "251-631-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5907 HIGHWAY 90",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636536",
            "telephone_number": "228-769-2611",
            "fax_number": "228-762-1638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISISSIPPI PROVIDENCE HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-13",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "CHRISTIANSON",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-631-3574",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve McMellon, RPH
• Vicki McMillan
• Medi Mart Pharmacies of Mississippi, Inc.
• Janice L Miles, DO
• Miller Pharmacy
• Missing Peace Enterprise
• Moss Point Family Clinic
• Moss Point Foot Clinic, LLC
• Moss Point Visionary Circle Inc
• Ms Singing LLC

• All providers in Moss Point, MS
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; 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.