Family Health Care Clinic, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FAMILY HEALTH CARE CLINIC, INC

Practice address

213 South County Road
10 B
Taylorsville, MS 39168

Phone

(601) 825-7280

Fax

(601) 825-8130

NPI assigned

Aug 31, 2009

Last updated

Jul 3, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karina Marie Clayton

Title

Chief Financial Officer

Phone

(601) 825-7280

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710110374. Details of each certification follow.

• CCN 251001 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 251001

Legal name

FAMILY HEALTH CARE CLINIC INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 25, 2009

Last certification

Sep 25, 2009

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 1, 1996 in MS

Enrollment address

298 Highway 18
Bay Springs, MS 39422-5106

Other NPIs on the same Medicare enrollment 37

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

• Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Meadville, MS
  • NPI 1235371659

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Brandon, MS
  • NPI 1346266616

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Grenada, MS
  • NPI 1629224696

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Brookhaven, MS
  • NPI 1689816001

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Calhoun City, MS
  • NPI 1720234248

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc

  • Federally Qualified Health Center (FQHC)
  • Bay Springs, MS
  • NPI 1952873994

  O20040831001179, O20090917000349

  Same enrollment
• Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bogue Chitto, MS
  • NPI 1033342134

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Magee, MS
  • NPI 1033342688

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pearl, MS
  • NPI 1043236326

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Water Valley, MS
  • NPI 1083087985

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Monticello, MS
  • NPI 1093731234

  O20040831001179

  Same enrollment
• Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bude, MS
  • NPI 1104059146

  O20040831001179

  Same enrollment

Locations

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.

Practitioners 1

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.

• Jenny Taylor, FNP-BC

  • Family Nurse Practitioner
  • Grenada, MS
  • NPI 1669971180
  NPD

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530576000000",
    "number": "1710110374",
    "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": "213 SOUTH COUNTY ROAD",
            "address_2": "10 B",
            "city": "TAYLORSVILLE",
            "state": "MS",
            "postal_code": "39168",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2018-07-03",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "KARINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "601-825-7280"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03339256",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Taylorsville, MS
• Providers in Taylorsville, MS by specialty
• Federally Qualified Health Center (FQHC) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.