Tupelo Plastic Surgery Clinic of Tupelo PA

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

TUPELO PLASTIC SURGERY CLINIC OF TUPELO PA

Practice address

4381 S Eason Blvd Ste 101
Longtown Medical Park
Tupelo, MS 38801-6586

Phone

(662) 377-6630

Fax

(662) 377-6635

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Robert BuckleyNPI 1093786980

Title

MD

Phone

(662) 377-6630

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

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

• Robert Charles Buckley, MD

  • Plastic Surgery Physician
  • Tupelo, MS
  • NPI 1093786980
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204243200000",
    "number": "1649381104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E PRESIDENT AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015599",
            "telephone_number": "662-377-4685",
            "fax_number": "662-377-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4381 S EASON BLVD STE 101",
            "address_2": "LONGTOWN MEDICAL PARK",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016586",
            "telephone_number": "662-377-6630",
            "fax_number": "662-377-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUPELO PLASTIC SURGERY CLINIC OF TUPELO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-02-29",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "662-377-6630"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00110707",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tupelo Pathology Group, P.a.
• Tupelo Sleep Diagnostics (The Reggie White Sleep Disorder Center - Tupelo)
• Tupelo Smiles Family and Cosmetic Dentistry
• Tupelo Specialty Pharmacy, LLC
• Tupelo Surgery Center, L.L.C.
• Tupelo Urology Center

• Plastic Surgery Physician in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Plastic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.