Family Health Care Clinic, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Flowood, MS
NPI 1689440133 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1689440133
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FAMILY HEALTH CARE CLINIC, INC.
- Practice address
- 544 Keyway Dr Ste a
Flowood, MS 39232-9580 - Phone
- (601) 825-7280
- Fax
- (601) 825-8130
- NPI assigned
- Nov 27, 2023
- Organization subpart
- No
Authorized official
- Name
- Margaret A Gray, DPA
- Title
- President and Ceo
- Phone
- (601) 825-7280
Other NPIs on the same Medicare enrollment 37
Corporate family (same tax ID) 35
Practitioners 81
-
Chastity A Barnette, CFNP
-
Constance M. Bradford, FNP-C
-
Brittany Chantriece Burage, FNP-C
-
Ericia Latrice Cannon, NURSE PRACTITONER
-
Delecia Carter, FNP
-
Sudhir Kumar Chiluka, M.D
-
Teresa Conerly, NPC
-
Rhonda Cox, MSN, FNP-C/AGACNP-BC
-
Monica Davis, FNP-C
-
John C Farmer, M.D.
-
Esquanickia C Fletcher, FNP-BC
-
Khalilah C George, FNP
-
Reanna Henderson, FNP-C
-
Craig Damon Henry, MSN, APRN, FNP-C
-
Katherine W Hughes, FNP
-
Nashamba Jackson-Bracey, FNP-C
-
Lindsey Jackson, NP-C
-
Shadonna Johnson, NP
-
Zinat K Khandekar, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2296990 | Family Health Care Clinic, Inc-Flowood | Provider-performed microscopy | Jan 8, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Federally qualified health center certification: CCN 251165
- Legal name
- FAMILY HEALTH CARE CLINIC INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 18, 2024
- Last certification
- Jun 18, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 1, 1996 in MS
- Enrollment address
- 544 Keyway Dr
Ste a
Flowood, MS 39232-9580
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Brenda Blakeslee |
Corporate Director |
Sep 1, 2022 | |
| Cierra Hernandez |
Corporate Director |
Sep 1, 2022 | |
| Margaret a Gray |
Corporate Officer |
Jul 1, 1980 | |
| Corporate Director |
Jul 1, 1980 | ||
| W-2 Managing Employee |
Jul 1, 1980 | ||
| Charles Hatten |
Corporate Director |
Jan 1, 2003 | |
| Michael Howard |
Corporate Director |
Jan 1, 2006 | |
| Helen Johnson |
Corporate Director |
Sep 3, 2008 | |
| Louise Patterson |
Corporate Director |
Sep 3, 2008 | |
| Moses Johnson |
Corporate Director |
Sep 3, 2008 | |
| Carolyn Hartzog |
Corporate Director |
Feb 3, 2003 | |
| Lydia Gonzalez-Seals |
Corporate Director |
Sep 1, 2022 | |
| Cindy Bryan |
Corporate Director |
Jan 1, 2007 | |
| Eddie Thames |
Corporate Director |
Sep 3, 2008 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Family Health Care Clinic Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2009 |
| Family Health Care Clinic Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2009 |
| Family Health Care Clinic Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2009 |
| Family Health Care Clinic Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2009 |
| Family Health Care Clinic Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2009 |
| Family Health Care Clinic Inc |
Federally qualified health center | Operational/Managerial Control | Aug 1, 2009 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040831001179 | MS | Part B Supplier - Clinic/Group Practice | 5395656946 |
Receives reassigned benefits from 71 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Monticello, MS; Pearl, MS; Newhebron, MS; Pelahatchie, MS; Piney Woods, MS; Pinola, MS; Prentiss, MS; Raleigh, MS… |
| O20240715000437 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 5395656946 | Practice locations: Flowood, MS |
National Provider Directory
- Tax ID family
- Family Health Care Clin
Locations
102 Physicians Dr
Ste B
Muscle Shoals, AL 35661
Phone (256) 389-9797
5622 N Williamsburg Rd
Bassfield, MS 39421
2506 Highway 51 SE
Bogue Chitto, MS 39629
1551 W Government St
Brandon, MS 39042
Phone (601) 825-3163
290 Highway 51 N
Brookhaven, MS 39601
Phone (601) 823-1710
624 Highway 51 N
Brookhaven, MS 39601
Phone (601) 823-3098
290 Highway 51 N
#U
Brookhaven, MS 39601
Phone (601) 823-1710
262 Pine St N
Bude, MS 39630
301 Broad St
Columbia, MS 39429
Phone (601) 736-6877
620 Carrollton St
Duck Hill, MS 38925
1307 Airport Rd N
Ste 2
Flowood, MS 39232
Phone (601) 936-3485
631 Lakeland East Dr
Ste D
Flowood, MS 39232
Phone (601) 939-7488
1102 Telegraph St
Grenada, MS 38901
401 Main St N
Mendenhall, MS 39114
Phone (601) 847-3306
125 School Rd
Mize, MS 39116
Phone 60182572805021
4635 Highway 80 E
Pearl, MS 39208
Phone (601) 933-2500
100 N Brooks Ave
Pelahatchie, MS 39145
Phone (601) 854-6805
150 J E Johnson Rd
Prentiss, MS 39474
226 Whiteoak Ave
Raleigh, MS 39153
Phone (601) 782-9919
65 Morgan Fork Church Ln NW
Roxie, MS 39661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
544 Keyway Dr Ste a
Flowood, MS 39232-9580
Mailing address
PO Box 24116
Jackson, MS 39225-4116
Phone (601) 825-7280
Other providers in Flowood, MS
- Eyecare Professionals of Mississippi, PLLC
- Eyecare Professionals PA
- Charles Frederick Ezelle
- F and M Specialty Pharmacy Inc
- Family Dental Care
- Family Health Care Clinic, Inc.
- Erin Janell Farmer
- Debra Lane Fatherree
- Emily Callaway Faulkner
- Rose Mary Favre
All providers in Flowood, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.