NPIMap

Organization Active NPI

Phyllis G Koonce

Doing business as Cotton Plant Family Clinic

  • Rural Health Clinic/Center
  • Blue Mountain, MS
National Provider Identifier
1891911186
Registry record updated Jul 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
R125960 Issued in MS
Legal business name
PHYLLIS G KOONCE
Doing business as
Cotton Plant Family Clinic
Practice address
100 County Road 714
Blue Mountain, MS 38610-9743
Phone
(662) 538-4111
Fax
(662) 538-4128
NPI assigned
Apr 17, 2007
Last updated
Jul 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2008

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

Authorized official

Name
Mrs. Phyllis G Koonce, CFNPNPI 1215948047
Title
Owner Sole Provider
Phone
(662) 538-4111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X R125960 MS Primary

Addresses

Primary practice location

100 County Road 714
Blue Mountain, MS 38610-9743

Mailing address

100 County Road 714
Blue Mountain, MS 38610-9743
Phone (662) 538-4111

Other identifiers 1

IdentifierTypeStateIssuer
06577891MedicaidMS

Other names 1

  • Cotton Plant Family Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1891911186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD 714",
            "city": "BLUE MOUNTAIN",
            "state": "MS",
            "postal_code": "386109743",
            "telephone_number": "662-538-4111",
            "fax_number": "662-538-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD 714",
            "city": "BLUE MOUNTAIN",
            "state": "MS",
            "postal_code": "386109743",
            "telephone_number": "662-538-4111",
            "fax_number": "662-538-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYLLIS G KOONCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "KOONCE",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER SOLE PROVIDER",
        "authorized_official_telephone_number": "662-538-4111",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "R125960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06577891",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cotton Plant Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Mountain, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; 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.