NPIMap

Organization Active NPI

Claiborne County Family Health Center, Inc.

Doing business as P G Middle School School Base Clinic

  • Federally Qualified Health Center (FQHC)
  • Port Gibson, MS
National Provider Identifier
1881859338
Registry record updated Dec 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CLAIBORNE COUNTY FAMILY HEALTH CENTER, INC.
Doing business as
P G Middle School School Base Clinic
Practice address
161 Ramsey Dr
2045 Highway 61 North
Port Gibson, MS 39150-2531
Phone
(601) 437-9021
Fax
(601) 437-3051
NPI assigned
Jul 24, 2008
Last updated
Dec 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2011

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

Authorized official

Name
Mrs. Ladonna Davis
Title
Chief Operating Officer
Phone
(601) 437-3050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MS Primary

Addresses

Primary practice location

161 Ramsey Dr
2045 Highway 61 North
Port Gibson, MS 39150-2531

Mailing address

2045 Highway 61 N
P O Box 741
Port Gibson, MS 39150-4262
Phone (601) 437-9021

Other identifiers 1

IdentifierTypeStateIssuer
03907367MedicaidMS

Other names 1

  • P G Middle School School Base Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Claiborne County Family Health Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2045 Highway 61 N
Port Gibson, MS 39150
Phone (601) 437-3049

NPI Registry JSON

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324252800000",
    "number": "1881859338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 HIGHWAY 61 N",
            "address_2": "P O BOX 741",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391504262",
            "telephone_number": "601-437-9021",
            "fax_number": "601-437-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 RAMSEY DR",
            "address_2": "2045 HIGHWAY 61 NORTH",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "391502531",
            "telephone_number": "601-437-9021",
            "fax_number": "601-437-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAIBORNE COUNTY FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-24",
        "last_updated": "2011-12-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LADONNA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "601-437-3050",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03907367",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "P G Middle School School Base Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Gibson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.