CHARLES LARRY MCCULLOUCH JR. (NPI# 1710964754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710964754 |
| Entity Type | Individual |
| Full Name | CHARLES LARRY MCCULLOUCH JR. |
| Credential | MD |
| Practice Address |
1560 North Oliver St. Brooksville MS 39739 |
| Practice Telephone | 6627384424 |
| Practice Fax Number | 6627384615 |
| Mailing Telephone | 6627384424 |
| Mailing Fax Number | 6627384615 |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2018-06-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 13953 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00125739 | 05 | |
| RAILROAD MEDICARE | P00147884 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 562 E Main St, Louisville, MS 393392742 | 6627795150 |
| Street Address |
1560 NORTH OLIVER ST. |
| City | BROOKSVILLE |
| State | MS |
| Zip Code | 39739 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124644968 | First Choice Family Medical Clinic, LLC | Clinic/Center | 50 Highway 388, Brooksville, MS 39739 | 2020-06-17 |
| 1083139455 | Williams Care Company | In Home Supportive Care | 3695 Drake Hill Rd, Brooksville, MS 39739 | 2017-08-07 |
| 1396049185 | John D Owings IIi | Pharmacist | 312 North Oliver St., Brooksville, MS 39739 | 2011-01-07 |
| 1417180712 | John C Mason | Pharmacist | 139 North Oliver St., Brooksville, MS 39739 | 2009-09-02 |
| 1669657565 | Noxubee General Critical Access Hospital | Clinic/Center | 139 North Oliver Street, Brooksville, MS 39739 | 2008-01-09 |
| 1023150786 | Brooksville Clinical Laboratory, Inc. | Clinical Medical Laboratory | 139 N Oliver Street, Brooksville, MS 39739 | 2007-02-12 |
| 1609949692 | Kim Willams Truesdale | Nurse Practitioner | 139 North Oliver St, Brooksville, MS 39739 | 2006-11-16 |
| 1104843671 | Freds Stores of Tennessee Inc | Pharmacy | 25 Main Street, Brookesville, MS 39739 | 2006-07-17 |
| 1922171826 | Brooksville Medical Clinic Inc | Clinic/Center | 139 N. Oliver St., Brooksville, MS 39739-0348 | 2006-11-16 |
| 1639211121 | Macon City Drug Store, Inc. | Pharmacy | 1556 N Oliver St, Brooksville, MS 39739-4003 | 2007-02-13 |
| Find all providers in zip 39739 | ||||
| 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 |
|---|---|---|---|---|
| 1407405822 | Medical Risk Solutions | Family Medicine | 12080 Cortez Blvd, Brooksville, FL 34613 | 2019-09-09 |
| 1316196744 | Osteopathic Heritage, P.a. | Family Medicine | 959 W Jefferson St, Brooksville, FL 34601-2427 | 2008-09-10 |
| 1942335104 | Brooksville Walk In Clinic LLC | Family Medicine | 433 W Jefferson St, Brooksville, FL 34601-2500 | 2007-02-21 |
| 1669580668 | Mark D Bowden | Family Medicine | 31075 Cortez Blvd, Brooksville, FL 34602-7542 | 2006-08-29 |
| 1013025022 | Ridge Manor Family Medicine,llc | Family Medicine | 31158 Cortez Blvd, Brooksville, FL 34602-7552 | 2006-08-29 |
| 1417963778 | Mauricio Bermudez | Family Medicine | 12900 Cortez Blvd Ste 102, Brooksville, FL 34613-6897 | 2006-07-31 |
| 1164456059 | Brian M Roebuck | Family Medicine | 11329 Cortez Blvd, Brooksville, FL 34613-5407 | 2006-07-10 |
| 1134152044 | Jatin Natvarlal Sheth | Family Medicine | 920 W Jefferson St, Brooksville, FL 34601-2428 | 2006-07-07 |
| 1578591095 | Michael Rhea King | Family Medicine | 44 Veterans Ave, Brooksville, FL 34601-3215 | 2006-06-30 |
| 1033169487 | Manjari Ilesh Patel | Family Medicine | 11375 Cortez Blvd., State Rd 50, Oak Hill Hospital, Brooksville, FL 34613 | 2006-05-10 |
| Find all providers in BROOKSVILLE | ||||
| City | BROOKSVILLE |
| Zip Code | 39739 |
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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.