NPIMap

Organization Active NPI

Lighthouse Pediatric & After Hours Clinic, PA

  • Pediatrics Physician
  • Clinton, MS
National Provider Identifier
1881945475
Registry record updated Sep 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
16949 Issued in MS
Legal business name
LIGHTHOUSE PEDIATRIC & AFTER HOURS CLINIC, PA
Practice address
501 Springridge Rd
Clinton, MS 39056-5633
Phone
(601) 488-4171
Fax
(601) 488-4175
NPI assigned
Sep 24, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2012

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

Authorized official

Name
Dr. Tammy Lashelle Sims, M.D.
Title
Ceo
Phone
(601) 488-4171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 16949 MS Primary

Addresses

Primary practice location

501 Springridge Rd
Clinton, MS 39056-5633

Mailing address

501 Springridge Rd
Clinton, MS 39056-5633
Phone (601) 488-4171

Other identifiers 1

IdentifierTypeStateIssuer
04583552MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348444800000",
    "number": "1881945475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 SPRINGRIDGE RD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565633",
            "telephone_number": "601-488-4171",
            "fax_number": "601-488-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 SPRINGRIDGE RD",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565633",
            "telephone_number": "601-488-4171",
            "fax_number": "601-488-4175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE PEDIATRIC & AFTER HOURS CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-24",
        "last_updated": "2012-09-24",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "LASHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-488-4171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "16949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04583552",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; 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.