Children'S Clinic of Oxford, P.a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

10280 Issued in MS

Legal business name

CHILDREN'S CLINIC OF OXFORD, P.A.

Practice address

2888 S Lamar Blvd
Oxford, MS 38655-5347

Phone

(662) 234-8286

Fax

(662) 234-6644

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Joe Tanner Harris, M.D.

Title

Owner

Phone

(662) 234-8286

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN 258925

Legal name

CHILDREN'S CLINIC OXFORD

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 7, 1997

Last certification

Oct 18, 2022

Ownership / control type

1B

Facility address

2888 South Lamar Blvd
Oxford, MS 38655

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801916481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2888 S LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555347",
            "telephone_number": "662-234-8286",
            "fax_number": "662-234-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2888 S LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555347",
            "telephone_number": "662-234-8286",
            "fax_number": "662-234-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S CLINIC OF OXFORD, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "TANNER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-234-8286",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "10280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014633",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Oxford, MS
• Providers in Oxford, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.