The Clarkdale Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

THE CLARKDALE CLINIC, LLC

Practice address

6905 Highway 145 S
Meridian, MS 39301-9771

Phone

(601) 696-6736

Fax

(601) 696-6778

NPI assigned

Feb 6, 2018

Organization subpart

No

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

Authorized official

Name

Wanda Pierce

Title

Credentialing Specialist

Phone

(601) 781-8677

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517875200000",
    "number": "1790284693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 24TH PL",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393051686",
            "telephone_number": "601-696-6736",
            "fax_number": "601-696-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6905 HIGHWAY 145 S",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393019771",
            "telephone_number": "601-696-6736",
            "fax_number": "601-696-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CLARKDALE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-02-06",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "601-781-8677"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Meridian, MS
• Providers in Meridian, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; 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.