Individual provider Active NPI

Charles Leckie, D.O.

  • Family Medicine Physician
  • Tupelo, MS
National Provider Identifier
1861461378
Registry record updated Sep 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16467 Issued in MS
Practice address
903 Mississippi Dr
Tupelo, MS 38804-0928
Phone
(662) 377-4652
Fax
(662) 377-7925
NPI assigned
Mar 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16467 MS Primary

Addresses

Primary practice location

903 Mississippi Dr
Tupelo, MS 38804-0928

Mailing address

450 E President Ave
Tupelo, MS 38801-5599
Phone (662) 377-4685

Other identifiers 1

IdentifierTypeStateIssuer
00125648MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040920000587 MS Practitioner - Family Practice 5799753554 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Pontotoc Health Services, Inc. CurrentSince May 5, 2015 Accepting new patients
Pontotoc Health Services, Inc. Current Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Jun 1, 2012 Accepting new patients
Pontotoc Health Services, Inc. CurrentSince May 5, 2015 Accepting new patients
North Mississippi Medical Clinics Inc Family Medicine Current Accepting new patients

Locations

1913 Highway 45 N
Columbus, MS 39705
Phone (662) 328-1918

202 Main St
Ecru, MS 38841
Phone (662) 489-4345

400 Doctors Dr
New Albany, MS 38652
Phone (662) 534-5036

119 Robertson St
Okolona, MS 38860
Phone (662) 447-3882

2530 Jackson Ave W
Oxford, MS 38655
Phone (662) 236-5905

176 S Main St
Pontotoc, MS 38863
Phone (601) 489-5510

345 Highway 15 N
Pontotoc, MS 38863
Phone (662) 489-7430

845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025

903 Mississippi Dr
Tupelo, MS 38804
Phone (662) 377-4652

450 E President Ave
Tupelo, MS 38801
Phone (662) 377-3204

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1861461378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E PRESIDENT AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015599",
            "telephone_number": "662-377-4685",
            "fax_number": "662-377-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 MISSISSIPPI DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388040928",
            "telephone_number": "662-377-4652",
            "fax_number": "662-377-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECKIE",
        "first_name": "CHARLES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "16467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125648",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.