INDIANOLA CLINIC, LLC (NPI# 1679673917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679673917 |
| Entity Type | Organization |
| Organization Name | INDIANOLA CLINIC, LLC |
| Other Organization Name | LELAND MEDICAL CLINIC |
| Practice Address |
201 Baker Blvd Leland MS 38756 |
| Practice Telephone | 6626864121 |
| Practice Fax Number | 6626864770 |
| Mailing Telephone | 6626864121 |
| Mailing Fax Number | 6626864770 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2018-11-14 |
| Authorized Official Name | MRS. AMY MCINTIRE (CREDENTIALING) |
| Authorized Official Telephone | 6626863956 |
| Is Organization Subpart | Y |
| Parent Organization Name | INDIANOLA CLINIC, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09016086 | 05 |
| Other Name | Type Code |
|---|---|
| Leland Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962940908 | Indianola Clinic, LLC | Occupational Therapy Assistant | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-02-10 |
| 1164964565 | Indianola Clinic, LLC | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2016-11-16 |
| 1942758131 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756-3401 | 2016-09-15 |
| 1902906258 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756-3401 | 2006-09-25 |
| Street Address |
201 BAKER BLVD |
| City | LELAND |
| State | MS |
| Zip Code | 38756 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134164916 | Heather Lloyd | Nurse Practitioner | 201 Baker Blvd, Leland, MS 38756 | 2006-06-17 |
| 1962043281 | Robdreka Shaw | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2019-10-08 |
| 1366942971 | Nicole Bradley Andrews | Speech-Language Pathologist | 201 Baker Blvd, Leland, MS 38756 | 2018-02-20 |
| 1427565886 | Abbie Sightler Robinson | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2018-01-08 |
| 1174036792 | Carrie Whitt | Speech-Language Pathologist | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-11-06 |
| 1710499447 | Mary Catherine Ruscoe | Speech-Language Pathologist | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-11-03 |
| 1326550468 | Sheena Brown | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-10-30 |
| 1326561895 | Nash Burnside | Occupational Therapy Assistant | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-07-17 |
| 1982127445 | Lauren Austin | Physical Therapy Assistant | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-07-17 |
| 1669903001 | Amanda Leigh Suell | Occupational Therapist | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447705314 | Elizabeth Bell | Physical Therapist | 28 S. Point Dr., Leland, MS 38756 | 2016-08-22 |
| 1902138050 | Leland School District | Local Education Agency (LEA) | 408 East Fourth Street, Leland, MS 38756 | 2010-01-31 |
| 1275631699 | Mississippi Holistic Hospice Care Inc | Hospice Care, Community Based | 109 East Street, Unit A, Leland, MS 38756 | 2006-09-20 |
| 1104933316 | James M Huoni Sr. | Dentist | 305 No Broad Street, Leland, MS 38756 | 2006-08-24 |
| 1427468073 | Mississippi State Department of Health | Public Health or Welfare | 801 N Broad St, Leland, MS 38756-2546 | 2014-05-05 |
| 1578926655 | Latoyia Cole | In Home Supportive Care | 511 N Main St, Leland, MS 38756-2657 | 2016-04-05 |
| 1548735558 | A & A Infusion & Specialty, LLC | Pharmacy | 125 E 3rd St, Leland, MS 38756-2705 | 2018-10-05 |
| 1699233916 | Cox Healthcare Clinic, LLC | Clinic/Center | 402 E 3rd St, Leland, MS 38756-2712 | 2019-03-05 |
| 1235772070 | Gail M Sims | Pharmacist | 311 N Main St, Leland, MS 38756-2738 | 2019-10-24 |
| 1598235913 | Leland Drug Company, Inc | Pharmacy | 311 N Main St, Leland, MS 38756-2738 | 2018-11-28 |
| Find all providers in zip 38756 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902906258 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756-3401 | 2006-09-25 |
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|---|---|---|---|---|
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| 1306460282 | Covington County Hospital | Clinic/Center | 105 Eaton St, Taylorsville, MS 39168-5614 | 2020-06-05 |
| 1871117747 | Covington County Hospital | Clinic/Center | 1039 Highway 42 Ste C, Sumrall, MS 39482-4478 | 2020-06-05 |
| 1194365338 | Bounds Family Medical | Clinic/Center | 870 Main St Ste A, Fayette, MS 39069-5695 | 2020-01-15 |
| 1720649577 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 19 Third St, Belmont, MS 38827 | 2019-06-24 |
| 1255999611 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 400 3rd Ave 32 West, New Houlka, MS 38850 | 2019-05-31 |
| 1598238545 | South Sunflower County Hospital | Clinic/Center | 1001 West Delta, Moorhead, MS 38761 | 2019-01-02 |
| 1790272185 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 670 Ms-178, Suite 5, Sherman, MS 38869 | 2018-04-20 |
| 1124515515 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 2200 5th St N, Columbus, MS 39705-2212 | 2018-04-20 |
| 1205323698 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 815 2nd Ave N, Columbus, MS 39701-4703 | 2018-04-20 |
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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.