HATTIESBURG CLINIC PA (NPI# 1417046574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417046574 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC PA |
| Other Organization Name | HEIDELBERG MEDICAL CLINIC |
| Practice Address |
2013 North Pine Heidelberg MS 39439 |
| Mailing Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6017872337 |
| Practice Fax Number | 6017872347 |
| Mailing Telephone | 6015795488 |
| Mailing Fax Number | 6015795240 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-08-27 |
| Authorized Official Name | TOMMY G THORNTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6012685601 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09016201 | 05 |
| Other Name | Type Code |
|---|---|
| Heidelberg Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831251925 | Hattiesburg Clinic Pa | Clinic/Center | 101 Courtenay Cir, Hattiesburg, MS 39402-3153 | 2006-12-14 |
| 1649332735 | Hattiesburg Clinic Pa | Psychologist | 2 Southern Point Pkwy Ste 201, Hattiesburg, MS 39401-8025 | 2006-12-14 |
| 1033270921 | Hattiesburg Clinic Pa | Internal Medicine | 940 Matthew Dr, Waynesboro, MS 39367-2522 | 2006-12-13 |
| 1184785065 | Hattiesburg Clinic Pa | Ophthalmology | 6414 Highway 98 West, Suite 80, Hattiesburg, MS 39402 | 2006-12-13 |
| 1962599282 | Hattiesburg Clinic Pa | Physical Therapist | 206 Corinth Rd, Petal, MS 39465-2883 | 2006-10-06 |
| 1972690287 | Hattiesburg Clinic Pa | Ophthalmology | 321 S 11th Ave, Laurel, MS 39440-4316 | 2006-10-06 |
| 1114014479 | Hattiesburg Clinic Pa | Dermatology | 6 Medical Blvd, Hattiesburg, MS 39401-7230 | 2006-10-06 |
| 1104910322 | Hattiesburg Clinic Pa | Family Medicine | 300 Pine St, Taylorsville, MS 39168-5432 | 2006-10-03 |
| 1730272931 | Hattiesburg Clinic Pa | Family Medicine | 801 Main Ave S, Magee, MS 39111-4102 | 2006-10-02 |
| 1720188030 | Hattiesburg Clinic Pa | Family Medicine | 7148 Us Highway 98, Suite101, Hattiesburg, MS 39402-8446 | 2006-09-25 |
| Street Address |
2013 NORTH PINE |
| City | HEIDELBERG |
| State | MS |
| Zip Code | 39439 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083074959 | Jfmc Heidelberg, LLC | Clinic/Center | 1208 Academy Dr, Heidelberg, MS 39439 | 2016-03-04 |
| 1295871259 | Joyce Denise Barker | Nurse Practitioner | 309 Pine Ave, Heidelberg, MS 39439 | 2007-01-29 |
| 1255354304 | Freds Stores of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 2005 North Pine Ave., Heidelberg, MS 39439 | 2006-07-26 |
| 1255521480 | Outreach Health Services,inc. | Health Maintenance Organization | 309 Pine Ave, Heidelberg, MS 39439 | 2007-07-25 |
| 1114577400 | Caldonia Livingston Satcher | Technician | 3840 Highway 528, Heidelberg, MS 39439-3370 | 2019-09-18 |
| 1346794120 | Family Home Care, LLC | Home Health | 309 Bay St, Heidelberg, MS 39439-3547 | 2016-08-09 |
| 1013328244 | Mississippi State Department of Health | Public Health or Welfare | 309 Bay Street, Heidelberg, MS 39439-3547 | 2014-05-09 |
| 1891204574 | Taylormade Heath Solutions LLC | Durable Medical Equipment & Medical Supplies | 306 Main Street, Heidelberg, MS 39439-3943 | 2017-09-25 |
| 1639532112 | A Touch of Heaven, LLC | Home Health | 227b County Road 371, Heidelberg, MS 39439-4991 | 2016-04-01 |
| 1215353867 | Southern Hospitality Home Care LLC | Home Health | 84 County Road 3771, Heidelberg, MS 39439-5016 | 2014-03-06 |
| Find all providers in zip 39439 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900581 | Maegan Cook Bridges | Family Medicine | 312 Ridge Pointe Dr, Brandon, MS 39042-5035 | 2020-10-24 |
| 1003415266 | Christian Fortenberry | Family Medicine | 786 Lake Harbour Dr, Ridgeland, MS 39157-4303 | 2020-10-20 |
| 1457967226 | Tiffine Lynn Prisock | Family Medicine | 24978 Ms-15, Mathiston, MS 39752 | 2020-09-17 |
| 1851902860 | Jasmine Lester | Family Medicine | 538 Getwell Rd S, Hernando, MS 38632-9585 | 2020-08-12 |
| 1942810569 | Ericka Marcene Williams | Family Medicine | 1031 Northridge Rd Ste A, Baldwyn, MS 38824-1173 | 2020-08-07 |
| 1316557986 | Independent Healthcare Management, Inc | Family Medicine | 376 Simpson Highway 149 Ste 600, Magee, MS 39111-3572 | 2020-08-07 |
| 1164031373 | Rohith Reddy Guduru Venkata | Family Medicine | Delta Regional Medical Center, 1400 E Union St, Greenville, MS 38703 | 2020-07-24 |
| 1831707470 | Rebecca Holmes | Family Medicine | 42 Atley Holmes Rd # Rs, Jayess, MS 39641-8272 | 2020-07-20 |
| 1497373344 | Dhruval Patel | Family Medicine | 564 Cypress Ln Apt 11d, Greenville, MS 38701-7415 | 2020-07-08 |
| 1881211258 | Tiffany Chapman | Family Medicine | 905 S Frontage Rd, Meridian, MS 39301-6113 | 2020-07-01 |
| Find all providers with the same taxonomy | ||||
| City | HEIDELBERG |
| Zip Code | 39439 |
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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.