NPIMap

Organization Active NPI

Avalon Medical LLC

  • Family Medicine Physician
  • Iuka, MS
National Provider Identifier
1710216346
Registry record updated Oct 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AVALON MEDICAL LLC
Practice address
1413 W Quitman St
Iuka, MS 38852-1130
Phone
(662) 424-9550
NPI assigned
Dec 10, 2009
Last updated
Oct 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2011

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

Authorized official

Name
Tommy Draper
Title
Member
Phone
(662) 424-9550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1413 W Quitman St
Iuka, MS 38852-1130

Mailing address

1413 W Quitman St
Iuka, MS 38852-1130
Phone (662) 424-9550

Other identifiers 1

IdentifierTypeStateIssuer
04352560MedicaidMS

National Provider Directory

National Provider Directory

Locations

1413 W Quitman St
Iuka, MS 38852
Phone (662) 423-6014

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1710216346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1413 W QUITMAN ST",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388521130",
            "telephone_number": "662-424-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 W QUITMAN ST",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388521130",
            "telephone_number": "662-424-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "DRAPER",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "662-424-9550"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04352560",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Iuka, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; 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.