NPIMap

Organization Active NPI

Chickasaw FMC

  • Family Medicine Physician
  • Okolona, MS
National Provider Identifier
1710101902
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CHICKASAW FMC
Practice address
518 West Dr
Okolona, MS 38860-1624
Phone
(662) 447-2255
NPI assigned
Apr 12, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Chris Dedeaux
Title
Clinic Administrator
Phone
(622) 256-7112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

518 West Dr
Okolona, MS 38860-1624

Mailing address

123 Main St N
Amory, MS 38821-3416

National Provider Directory

National Provider Directory
Tax ID family
Amory Hma Physician Management LLC17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710101902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 MAIN ST N",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388213416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 WEST DR",
            "city": "OKOLONA",
            "state": "MS",
            "postal_code": "388601624",
            "telephone_number": "662-447-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW FMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEDEAUX",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "622-256-7112"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okolona, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.