NPIMap

Organization Active NPI

Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Flowood, MS
National Provider Identifier
1689440133
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Margaret A Gray, DPA
Title
President and Ceo
Phone
(601) 825-7280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689440133. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 1, 1996 in MS
Enrollment address
544 Keyway Dr
Ste a
Flowood, MS 39232-9580

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2296990Family Health Care Clinic, Inc-Flowood544 Keyway Drive, Flowood, MS 39232Provider-performed microscopyJan 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Family Health Care Clin36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

16410 Highway 72
#U
Rogersville, AL 35652
Phone (256) 247-3154

5622 N Williamsburg Rd
Bassfield, MS 39421

290 Highway 51 N
#U
Brookhaven, MS 39601
Phone (601) 823-1710

125 Carter Dr
Calhoun City, MS 38916
Phone (662) 628-8267

301 Broad St
Columbia, MS 39429
Phone (601) 736-6877

431 Old Highway 13 S
Columbia, MS 39429
Phone 60182572805021

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

401 Main St N
Mendenhall, MS 39114
Phone (601) 847-3306

430 W Broad St
Monticello, MS 39654
Phone (601) 587-4492

226 Whiteoak Ave
Raleigh, MS 39153
Phone (601) 782-9919

65 Morgan Fork Church Ln NW
Roxie, MS 39661

213 Smith County Road 10B
Taylorsville, MS 39168

130 E Lexie Rd
Tylertown, MS 39667

225 Saint Paul Rd
Tylertown, MS 39667

1495 US Highway 61 S
Woodville, MS 39669
Phone (601) 888-3518

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brenda Blakeslee Individual Corporate DirectorBoard Member Sep 1, 2022
Cierra Hernandez Individual Corporate DirectorBoard Member Sep 1, 2022
Margaret a Gray Individual Corporate OfficerPresident and Ceo Jul 1, 1980
Corporate DirectorPresident and Ceo Jul 1, 1980
W-2 Managing EmployeePresident and Ceo Jul 1, 1980
Charles Hatten Individual Corporate DirectorBoard Member Jan 1, 2003
Michael Howard Individual Corporate DirectorBoard Member-Treasurer Jan 1, 2006
Helen Johnson Individual Corporate DirectorBoard Member-Secretary Sep 3, 2008
Louise Patterson Individual Corporate DirectorBoard Member-Chair Sep 3, 2008
Moses Johnson Individual Corporate DirectorBoard Member-Vice Chair Sep 3, 2008
Carolyn Hartzog Individual Corporate DirectorBoard Member Feb 3, 2003
Lydia Gonzalez-Seals Individual Corporate DirectorBoard Member-Officer Sep 1, 2022
Cindy Bryan Individual Corporate DirectorBoard Member Jan 1, 2007
Eddie Thames Individual Corporate DirectorBoard Member Sep 3, 2008

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Health Care Clinic IncRussellville, AL, CCN 011965 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncMuscle Shoals, AL, CCN 011970 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncDecatur, AL, CCN 011967 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncTown Creek, AL, CCN 011966 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncFlorence, AL, CCN 011969 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncRogersville, AL, CCN 011971 Federally qualified health center Operational/Managerial Control Aug 1, 2009

Practitioners & affiliated clinicians

Practitioners 81

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.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1689440133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24116",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392254116",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "544 KEYWAY DR STE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329580",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "601-825-7280",
        "authorized_official_credential": "DPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.