Clay County Outpatient Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD7826 Issued in TN

Legal business name

CLAY COUNTY OUTPATIENT CLINIC

Practice address

102 Old Jefferson Street
Celina, TN 38551-4040

Phone

(931) 243-3576

Fax

(931) 243-2751

NPI assigned

Dec 17, 2007

Last updated

Dec 17, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Roberto S Mauricio, MDNPI 1184711673

Title

President

Phone

(931) 243-3576

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Roberto S Mauricio, MD

  • Family Medicine Physician
  • Celina, TN
  • NPI 1184711673
  Authorized official Same address or phone

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1992988638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 OLD JEFFERSON STREET",
            "city": "CELINA",
            "state": "TN",
            "postal_code": "385514040",
            "telephone_number": "931-243-3576",
            "fax_number": "931-243-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 OLD JEFFERSON STREET",
            "city": "CELINA",
            "state": "TN",
            "postal_code": "385514040",
            "telephone_number": "931-243-3576",
            "fax_number": "931-243-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY COUNTY OUTPATIENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A",
        "authorized_official_last_name": "MAURICIO",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-243-3576",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD7826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3152445",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Buck
• Heather Bussell
• Greda Cherry, APN
• City of Celina (Celina Fire Department EMS)
• Clay County Manor
• April Beth Collins, RN
• Copeland Medical Services
• Ashley Mae Copeland, COTA/L
• Jessie Lee Copeland Jr., M.D.
• County of Clay Office of County (Clay County EMS)

• Family Medicine Physician in Celina, TN
• Providers in Celina, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.