BRANCH MEDICAL CLINIC GULFPORT (NPI# 1275733644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275733644 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC GULFPORT |
| Practice Address |
5502 Marvin Shields Blvd Gulfport MS 39501 |
| Mailing Address |
5501 Marvin Shields Blvd Gulfport MS 39501-9007 |
| Practice Telephone | 2288225783 |
| Practice Fax Number | 2288713648 |
| Mailing Telephone | 8505056309 |
| Mailing Fax Number | 8505056908 |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2019-12-09 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | BRANCH MEDICAL CLINIC GULFPORT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194824516 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2006-09-22 |
| 1558773192 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-06-02 |
| Street Address |
5502 MARVIN SHIELDS BLVD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598173841 | Valarie Anne Chapmon | Social Worker | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-07-31 |
| 1558773192 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-06-02 |
| 1841630266 | Mari Elizabeth Lewis | Pediatrics | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2013-06-29 |
| 1043361785 | Pamela Ann Edwards | Nurse Practitioner | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750584363 | Eisenhower Army Medical Center | Clinic/Center | 1450 14th St, Hattiesburg, MS 39407-0001 | 2007-06-10 |
| 1104031194 | Eisenhower Army Medical Center | Clinic/Center | 1001 Hardy St, Hattiesburg, MS 39401-4165 | 2007-05-11 |
| 1609076033 | Branch Medical Clinic Meridian | Clinic/Center | 1801 Fuller Rd, Meridian, MS 39309-5106 | 2007-07-24 |
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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.