BRUCE T BLACK (NPI# 1730199290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730199290 |
| Entity Type | Individual |
| Full Name | BRUCE T BLACK |
| Credential | M.D. |
| Practice Address |
401 Baptist Dr Suite 104 Madison MS 39110-2009 |
| Mailing Address |
965 Ridge Lake Blvd Ste 103 Memphis TN 38120-9446 |
| Practice Telephone | 6016053858 |
| Practice Fax Number | 6016053898 |
| Mailing Telephone | 9012273255 |
| Mailing Fax Number | 9012278591 |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-02-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 18358 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 07401794 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891256491 | Bruce Ellis Black II | Behavioral Analyst | 12731 Marblestone Dr Ste 101, Woodbridge, VA 22192-8334 | 2019-03-27 |
| 1285185819 | Bruce Black | Licensed Psychiatric Technician | 2225 Challenger Way, Santa Rosa, CA 95407 | 2016-10-19 |
| 1871831875 | Bruce Stanley Black | Pharmacist | 402 E Dania Beach Blvd, Dania Beach, FL 33004-3040 | 2013-01-25 |
| 1770595217 | Bruce Charles Black | Psychiatry & Neurology | 372 Washington St, Wellesley, MA 02481-6202 | 2006-08-13 |
| Street Address |
401 BAPTIST DR SUITE 104 |
| City | MADISON |
| State | MS |
| Zip Code | 39110-2009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730554627 | Charles Thomas | Physical Therapy Assistant | 401 Baptist Dr, Suite 306, Madison, MS 39110-2009 | 2015-12-03 |
| 1407274426 | Ashley W Mcglawn | Pediatrics | 401 Baptist Dr, Madison, MS 39110-2009 | 2014-04-07 |
| 1679821409 | Rachel Bradshaw | Physical Therapist | 401 Baptist Dr, Suite 306, Madison, MS 39110-2009 | 2012-08-28 |
| 1003177551 | Jennifer S Jones | Physical Therapy Assistant | 401 Baptist Dr, Suite 306, Madison, MS 39110-2009 | 2012-05-31 |
| 1982988812 | Baptist Pt - Madison | Physical Therapist | 401 Baptist Dr, Suite 306, Madison, MS 39110-2009 | 2011-10-11 |
| 1104121821 | Brian Matthew Hendley | Community Health Worker | 401 Baptist Dr, Suite 306, Madison, MS 39110-2009 | 2011-01-12 |
| 1811292501 | Mark Leslie Grogan | Physical Therapy Assistant | 401 Baptist Dr, Suite 306, Madison, MS 39110-2009 | 2011-01-11 |
| 1073830790 | Timothy Chin-yu Chen | Family Medicine | 401 Baptist Dr, Suite 104, Madison, MS 39110-2009 | 2010-04-21 |
| 1437314515 | Napdocs LLC | Physiological Laboratory | 401 Baptist Dr, Suite 40, Madison, MS 39110-2009 | 2008-07-28 |
| 1902096837 | Medical Foundation of Central Mississippi, Inc | Internal Medicine | 401 Baptist Dr, Suite 304, Madison, MS 39110-2009 | 2007-07-26 |
| Find all providers in the same location | ||||
| 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 | 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 |
|---|---|---|---|---|
| 1275159998 | Beam Healthcare, Sc | Family Medicine | 25 W Main St Fl 5, Madison, WI 53703-3399 | 2020-06-18 |
| 1598390932 | Ashley Rae Woodcock | Family Medicine | 844 Slaughter Rd, Madison, AL 35758-8836 | 2020-03-05 |
| 1255974952 | Integrative Health Center of Central Wisconsin LLC | Family Medicine | 3205 E Washington Ave Ste A, Madison, WI 53704-4332 | 2019-10-25 |
| 1538628961 | Heidi Hollinger | Family Medicine | 145 Kelso Blvd, Madison, AL 35756-4285 | 2019-03-15 |
| 1902364383 | Robert Thomas Pepper | Family Medicine | 1740 Lions Club Rd Ste 100, Madison, GA 30650-4762 | 2019-03-05 |
| 1497240485 | Doctor-patient Medicine Inc | Family Medicine | 101 Westover Cir Ste B, Madison, AL 35758-4900 | 2018-06-22 |
| 1457863243 | Debra Ann Mandarino | Family Medicine | 4223 Mandan Cres # 4223, Madison, WI 53711-3063 | 2017-11-02 |
| 1407367683 | Roxanne L Brown | Family Medicine | 1210 Briarville Rd Bldg F, Madison, TN 37115-5136 | 2017-10-16 |
| 1871023242 | Tulio Romulo Figarola | Family Medicine | 225 Mill Walk Ct, Madison, AL 35758-1565 | 2017-06-18 |
| 1649704586 | Zaunklay Finnila | Family Medicine | 540 Hughes Rd Ste 4, Madison, AL 35758-8959 | 2017-04-18 |
| 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.