NPIMap

Organization Active NPI

Faith Family Clinic of Kossuth, LLC

  • Primary Care Clinic/Center
  • Corinth, MS
National Provider Identifier
1669810636
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FAITH FAMILY CLINIC OF KOSSUTH, LLC
Practice address
820 Highway 2
Corinth, MS 38834-7954
Phone
(662) 728-0162
Fax
(662) 728-0326
NPI assigned
Jun 11, 2013
Last updated
Jun 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Authorized official

Name
Kelly S Thornton, FNPNPI 1750492203
Title
Co-Owner/Provider
Phone
(662) 728-0162

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

820 Highway 2
Corinth, MS 38834-7954

Mailing address

820 Highway 2
Corinth, MS 38834-7954
Phone (662) 728-0162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130924000837 MS Part B Supplier - Clinic/Group Practice 7113161530 Receives reassigned benefits from 3 practitioners
Practice locations: Corinth, MS

National Provider Directory

National Provider Directory

Locations

820 Highway 2
Corinth, MS 38834
Phone (662) 286-0909

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCCCBD

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1669810636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 HIGHWAY 2",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388347954",
            "telephone_number": "662-728-0162",
            "fax_number": "662-728-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 HIGHWAY 2",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388347954",
            "telephone_number": "662-728-0162",
            "fax_number": "662-728-0326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH FAMILY CLINIC OF KOSSUTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "THORNTON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CO-OWNER/PROVIDER",
        "authorized_official_telephone_number": "662-728-0162",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jun 11, 2013; 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.