NPIMap

Organization Active NPI

Garden Park Physician Group-Specialty Care, LLC

  • Surgery Physician
  • Gulfport, MS
National Provider Identifier
1679668958
Registry record updated Mar 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
GARDEN PARK PHYSICIAN GROUP-SPECIALTY CARE, LLC
Practice address
15190 Community Rd
Suite 330
Gulfport, MS 39503-3485
Phone
(228) 539-9100
Fax
(228) 539-9133
NPI assigned
Oct 4, 2006
Last updated
Mar 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2013

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

Authorized official

Name
Mr. Todd Carlon
Title
VP
Phone
(816) 508-4090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

15190 Community Rd
Suite 330
Gulfport, MS 39503-3485

Mailing address

15190 Community Rd
Suite 330
Gulfport, MS 39503-3485
Phone (228) 539-9100

Other identifiers 2

IdentifierTypeStateIssuer
01681729MedicaidMS
3576014MedicaidMS

National Provider Directory

National Provider Directory

Locations

15190 Community Rd
Ste 140
Gulfport, MS 39503
Phone (228) 539-0489

Practitioners & affiliated clinicians

Practitioners 5

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1679668958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD",
            "address_2": "SUITE 330",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033485",
            "telephone_number": "228-539-9100",
            "fax_number": "228-539-9133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD",
            "address_2": "SUITE 330",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033485",
            "telephone_number": "228-539-9100",
            "fax_number": "228-539-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN PARK PHYSICIAN GROUP-SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "CARLON",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "816-508-4090",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01681729",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3576014",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.