Mississippi Center for Advanced Medicine PC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

14837/1.1 Issued in MS

Legal business name

MISSISSIPPI CENTER FOR ADVANCED MEDICINE PC

Doing business as

Mississippi Center for Advanced Medicine

Practice address

7731 Old Canton Rd Ste B
Madison, MS 39110-6115

Phone

(601) 499-0935

Fax

(601) 499-0936

NPI assigned

May 9, 2016

Organization subpart

No

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

Authorized official

Name

Spencer Sullivan, MD

Title

President and Ceo

Phone

(601) 863-9764

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Mississippi Center for Advanced Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Mississippi Center for Advanced Medicine, PC

  • Specialist
  • Madison, MS
  • NPI 1790227627

  O20160707000847

  Same enrollment

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

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1740636786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD",
            "address_2": "SUITE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106114",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD STE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106115",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CENTER FOR ADVANCED MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "601-863-9764",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "14837/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160699",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09587750",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi Center for Advanced Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Madison, MS
• Providers in Madison, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.