Onsite House Call Clinic
Organization Active NPI Primary Care Nurse Practitioner · Hamilton, MS
NPI 1922713544 · NPPES record last updated Feb 5, 2023
Key facts
- NPI
- 1922713544
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- Legal business name
- ONSITE HOUSE CALL CLINIC
- Practice address
- 40114 Grubb Springs Rd
Hamilton, MS 39746-9616 - Phone
- (662) 356-1511
- Fax
- (662) 356-1711
- NPI assigned
- Jan 18, 2023
- Organization subpart
- No
Authorized official
- Name
- Heather Leigh Holloway, NP
- Title
- Director
- Phone
- (662) 801-2826
Practitioners 1
-
Heather Leigh Holloway, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2275569 | Onsite House Call Clinic | Certificate of waiver | Jan 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230203000801 | MS | Part B Supplier - Clinic/Group Practice | 8224400015 |
Receives reassigned benefits from 1 practitioner Practice locations: Pontotoc, MS |
National Provider Directory
Locations
280 Turnpike Rd
Pontotoc, MS 38863
Phone (662) 356-1511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner |
363LP2300X | Yes |
Addresses
Primary practice location
40114 Grubb Springs Rd
Hamilton, MS 39746-9616
Mailing address
40114 Grubb Springs Rd
Hamilton, MS 39746-9616
Phone (662) 356-1511
Other providers in Hamilton, MS
- Shelby Chase Howell
- Lifebrite Hospital Group of Aberdeen LLC
- Martin Swoope Enterprises
- Mary Emily Nethery
- North Mississippi Gilmore Clinics, LLC
- Pioneer Family Pharmacy
- Pioneer Health Services of Monroe County, Inc.
- Shonderria L Roberts
- Cheryl Whitaker
- James S. Woodard
All providers in Hamilton, MS · Primary Care Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.