Organization Active NPI

Highland Community Clinic Network

  • Obstetrics & Gynecology Physician
  • Picayune, MS
National Provider Identifier
1730310335
Registry record updated Sep 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
19353 Issued in MS
Legal business name
HIGHLAND COMMUNITY CLINIC NETWORK
Practice address
801 Goodyear Blvd
Picayune, MS 39466-3221
Phone
(985) 726-2655
Fax
(985) 643-9808
NPI assigned
Jul 30, 2009
Organization subpart
Yes
Parent organization
HIGHLAND COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2011

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

Authorized official

Name
Mr. Bryan N. Stevens, CPA, FHFMA
Title
Cfo
Phone
(601) 749-3121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 19353 MS Primary

Addresses

Primary practice location

801 Goodyear Blvd
Picayune, MS 39466-3221

Mailing address

1375 Corporate Square Dr
Slidell, LA 70458-3147
Phone (985) 726-2655

Other identifiers 3

IdentifierTypeStateIssuer
DP4385OtherRAILROAD MCARE
03900238MedicaidMS
2112015MedicaidLA

National Provider Directory

National Provider Directory
Part of
Forrest County Gen Hospital

NPI Registry JSON

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317081600000",
    "number": "1730310335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 CORPORATE SQUARE DR",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704583147",
            "telephone_number": "985-726-2655",
            "fax_number": "985-643-9808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 GOODYEAR BLVD",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663221",
            "telephone_number": "985-726-2655",
            "fax_number": "985-643-9808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND COMMUNITY CLINIC NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HIGHLAND COMMUNITY HOSPITAL",
        "enumeration_date": "2009-07-30",
        "last_updated": "2011-09-27",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-749-3121",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, FHFMA"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MS",
            "license": "19353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE",
            "identifier": "DP4385",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03900238",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2112015",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Picayune, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.