Line Street Medical, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

LINE STREET MEDICAL, LLC

Practice address

562 Line St S Ste 1
Philadelphia, MS 39350-2144

Phone

(601) 562-6363

NPI assigned

Dec 20, 2018

Last updated

Apr 30, 2020By 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

Leah Denise Phillips, FNP-C

Title

Nurse Practitioner

Phone

(601) 562-6363

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21485/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1821560327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 LINE ST S STE 1",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 LINE ST S STE 1",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502144",
            "telephone_number": "601-562-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINE STREET MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-20",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "601-562-6363",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00724810",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Monty Lang, D.D.S.
• Elizabeth Land Latimer
• Cameron Gavin Lesley, DPT
• Anna Catherine Lewis, FNP-C
• Line Street Medical Clinic
• Beth Long
• Louisville Medical Supply Inc (Philadelphia Medical Supply Inc)
• Jerry Lovorn, MA, LPC.
• Betsy L Mann, FNP
• John E. Mann Jr., M.D.

• Family Nurse Practitioner in Philadelphia, MS
• Providers in Philadelphia, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; 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.