PSP MEDICAL CLINIC, LLC (NPI# 1245581370) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245581370 |
| Entity Type | Organization |
| Organization Name | PSP MEDICAL CLINIC, LLC |
| Other Organization Name | MAGNOLIA MEDICAL CLINICS |
| Practice Address |
1082 Gluckstadt Rd Madison MS 39110 |
| Mailing Address |
Po Box 607 Canton MS 39046 |
| Practice Telephone | 6017075621 |
| Mailing Telephone | 6018599888 |
| Mailing Fax Number | 6018599966 |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2020-10-29 |
| Authorized Official Name | PARVESH K. GOEL (MD) |
| Authorized Official Telephone | 6018599888 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Gluckstadt Family Clinic | Doing Business As Name - Organization |
| Magnolia Medical Clinics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033435680 | Psp Medical Clinic, LLC | Clinic/Center | 1171 Hart St., Canton, MS 39046 | 2010-04-07 |
| 1225320708 | Psp Medical Clinic, LLC | Clinic/Center | 1435 Grand Ave, Yazoo City, MS 39194 | 2011-05-03 |
| Street Address |
1082 GLUCKSTADT RD |
| City | MADISON |
| State | MS |
| Zip Code | 39110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952383812 | Sonya K. Goodin | Nurse Practitioner | 1082 Gluckstadt Rd, Madison, MS 39110 | 2005-11-16 |
| 1730799834 | Emilye Walker Welch | Nurse Practitioner | 1082 Gluckstadt Rd, Madison, MS 39110-7243 | 2020-08-04 |
| 1518522283 | Brianna Michelle Pendergrass | Family Medicine | 1082 Gluckstadt Rd, Madison, MS 39110-7243 | 2019-05-07 |
| 1710075031 | Gary Lamar Hamil | Nurse Practitioner | 1082 Gluckstadt Rd, Madison, MS 39110 | 2006-10-11 |
| 1407817240 | Reginald D Rigsby | Family Medicine | 1082 Gluckstadt Rd, Madison, MS 39110-7243 | 2006-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1386283471 | E A Mccleskey, Do, LLC | Clinic/Center | 103 Intercom Dr Ste B, Madison, AL 35758-2641 | 2020-01-06 |
| 1598248106 | Granite City Clinic Corp | Clinic/Center | 602 Farrish St, Madison, IL 62060-1567 | 2018-09-10 |
| 1669918843 | All About You Healthcare LLC | Clinic/Center | 342 E Old Hickory Blvd, Madison, TN 37115-3937 | 2017-01-12 |
| 1548713332 | Wellness for Life | Clinic/Center | 630 Broadway St Ste 2a, Madison, IN 47250-3310 | 2016-07-27 |
| 1871863050 | Patrick J Oneill M.d., P.C. | Clinic/Center | 104 Spenryn Dr, Madison, AL 35758-1890 | 2012-01-05 |
| 1003191867 | Gluckstadt Special Care Clinic | Clinic/Center | 1716 Highway 51 Ste M, Madison, MS 39110-5020 | 2011-10-12 |
| 1104071836 | W Kevin Britt M.d. LLC | Clinic/Center | 1801 Clifty Drive, Madison, IN 47250-1627 | 2008-11-21 |
| 1366057986 | Avalon Family Care LLC | Clinic/Center | 540 Hughes Rd Ste 4, Madison, AL 35758-8959 | 2020-09-10 |
| 1447868757 | Advent Health LLC | Clinic/Center | 1230 Slaughter Rd Ste C, Madison, AL 35758-5901 | 2020-07-22 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.