Lucedale Urgent Care, PC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

LUCEDALE URGENT CARE, PC

Doing business as

Lucedale Urgent Care, PC

Practice address

103 W Frontage Rd Ste C
Lucedale, MS 39452-5836

Phone

(251) 633-0123

Fax

(251) 445-3722

NPI assigned

Jul 10, 2018

Organization subpart

No

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

Authorized official

Name

Bridgot Peters

Title

Billing Director

Phone

(251) 445-7618

Specialties & licenses 2

Addresses

Other names 1

• Lucedale Urgent Care, PC Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

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

• Leigh Ann Havens, NP

  • Family Nurse Practitioner
  • Lucedale, MS
  • NPI 1437477163
  Medicare reassignment Care Compare group NPD
• Hollis Lee Ward, CRNP

  • Family Nurse Practitioner
  • Mobile, AL
  • NPI 1154341774

  MS

  Medicare reassignment Care Compare group NPD
• Tara Leann Tillman, FNP

  • Family Nurse Practitioner
  • Lucedale, MS
  • NPI 1245129030
  Medicare reassignment NPD
• Jessica Danielle Gates, CRNP

  • Family Nurse Practitioner
  • Mobile, AL
  • NPI 1235653742

  MS

  Medicare reassignment NPD

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1700372034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W FRONTAGE RD STE C",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394525836",
            "telephone_number": "601-947-9596",
            "fax_number": "251-445-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W FRONTAGE RD STE C",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394525836",
            "telephone_number": "251-633-0123",
            "fax_number": "251-445-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCEDALE URGENT CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-10",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "BRIDGOT",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "251-445-7618"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lucedale Urgent Care, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lucedale Chiropractic LLC
• Lucedale Family Medical Clinic
• Lucedale Intermediate School
• Lucedale OB/GYN Center
• Lucedale OBGYN Center
• Tara S. Mallett, D.O.
• Ashley Renee Mann, PHARMD
• Benjamin A. Marble, MD
• Cesaley Martin
• Bernard Anthony Matherne Jr., MS,ICADCII

• Multi-Specialty Clinic/Center in Lucedale, MS
• Providers in Lucedale, MS by specialty
• Multi-Specialty Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.