Line Street Medical Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LINE STREET MEDICAL CLINIC

Practice address

562 Line St S BLDG a
Philadelphia, MS 39350-2144

Phone

(601) 389-8223

Fax

(833) 640-0468

NPI assigned

Jun 27, 2022

Last updated

Jun 27, 2022By 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

Sierra CainNPI 1063017093

Title

FNP-C/Owner

Phone

(601) 562-6707

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Sierra Cain, NP-C

  • Family Nurse Practitioner
  • Philadelphia, MS
  • NPI 1063017093
  NPD Authorized official

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

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1730811944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 LINE ST S BLDG A",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502144",
            "telephone_number": "601-389-8223",
            "fax_number": "833-640-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 LINE ST S BLDG A",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502144",
            "telephone_number": "601-389-8223",
            "fax_number": "833-640-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINE STREET MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "CAIN",
        "authorized_official_first_name": "SIERRA",
        "authorized_official_title_or_position": "FNP-C/OWNER",
        "authorized_official_telephone_number": "601-562-6707"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01805219",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laird Hospital, Inc. (Ochsner Health Center- Philadelphia)
• James Monty Lang, D.D.S.
• Elizabeth Land Latimer
• Cameron Gavin Lesley, DPT
• Anna Catherine Lewis, FNP-C
• Line Street Medical, LLC
• Beth Long
• Louisville Medical Supply Inc (Philadelphia Medical Supply Inc)
• Jerry Lovorn, MA, LPC.
• Betsy L Mann, FNP

• Primary Care Clinic/Center in Philadelphia, MS
• Providers in Philadelphia, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.