The Cranial Prosthesis Center of Mississippi LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

THE CRANIAL PROSTHESIS CENTER OF MISSISSIPPI LLC

Practice address

717 Rice Rd Ste G
Ridgeland, MS 39157-3041

Phone

(601) 790-7269

Fax

(601) 590-8991

NPI assigned

Jan 11, 2021

Organization subpart

No

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

Authorized official

Name

Tierra StephensNPI 1053984583

Title

Owner

Phone

(769) 237-0443

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

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

• Tierra Stephens

  • Prosthetic/Orthotic Supplier
  • Ridgeland, MS
  • NPI 1053984583
  NPD Authorized official

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1669061032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 RICE RD STE G",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391573041",
            "telephone_number": "601-790-7269",
            "fax_number": "601-590-8991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 RICE RD STE G",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391573041",
            "telephone_number": "601-790-7269",
            "fax_number": "601-590-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CRANIAL PROSTHESIS CENTER OF MISSISSIPPI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-11",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "TIERRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "769-237-0443"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "6015908991",
            "affiliation": "N",
            "endpointDescription": "FAX",
            "address_1": "717 Rice Rd Ste G",
            "city": "Ridgeland",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391573041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Prosthetic/Orthotic Supplier in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.