NPIMap

Organization Active NPI

McComb Skin Clinic PA

  • Dermatology Physician
  • McComb, MS
National Provider Identifier
1740448653
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
7285 Issued in MS
Legal business name
MCCOMB SKIN CLINIC PA
Practice address
136 Marion Ave
McComb, MS 39648-3620
Phone
(601) 684-3210
Fax
(601) 684-3319
NPI assigned
May 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Mrs. Linda Young Brock
Title
Office Administrator
Phone
(601) 684-3210

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 7285 MS Primary

Addresses

Primary practice location

136 Marion Ave
McComb, MS 39648-3620

Mailing address

136 Marion Ave
McComb, MS 39648-3620
Phone (601) 684-3210

Other identifiers 1

IdentifierTypeStateIssuer
09014899MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1740448653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483620",
            "telephone_number": "601-684-3210",
            "fax_number": "601-684-3319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483620",
            "telephone_number": "601-684-3210",
            "fax_number": "601-684-3319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCOMB SKIN CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-28",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "YOUNG",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "601-684-3210",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MS",
            "license": "7285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014899",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McComb, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.