NPIMap

Organization Active NPI

Ivancic Pediatric Clinic PA

  • Primary Care Clinic/Center
  • Tupelo, MS
National Provider Identifier
1942606256
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
IVANCIC PEDIATRIC CLINIC PA
Practice address
499 Gloster Creek VLG
Suite H-3
Tupelo, MS 38801-4600
Phone
(662) 840-6026
Fax
(662) 840-6030
NPI assigned
Nov 13, 2014
Last updated
Jan 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Authorized official

Name
Mrs. Mitzi Parsons
Title
Office Manager
Phone
(662) 840-6026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

499 Gloster Creek VLG
Suite H-3
Tupelo, MS 38801-4600

Mailing address

499 Gloster Creek VLG
Suite H-3
Tupelo, MS 38801-4600
Phone (662) 840-6026

National Provider Directory

National Provider Directory

Locations

499 Gloster Creek Vlg
Ste H3
Tupelo, MS 38801
Phone (662) 840-6026

Practitioners & affiliated clinicians

Practitioners 4

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": "1415836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1942606256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG",
            "address_2": "SUITE H-3",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-840-6026",
            "fax_number": "662-840-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG",
            "address_2": "SUITE H-3",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-840-6026",
            "fax_number": "662-840-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVANCIC PEDIATRIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-13",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "PARSONS",
        "authorized_official_first_name": "MITZI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-840-6026",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.