SAMUEL SCOTT MCCULLOUGH III (NPI# 1750923538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750923538 |
| Entity Type | Individual |
| Full Name | SAMUEL SCOTT MCCULLOUGH III |
| Credential | FNP-C |
| Practice Address |
120 Fountains Blvd # 1000 Madison MS 39110-6343 |
| Mailing Address |
144 Huber St Madison MS 39110-6983 |
| Practice Telephone | 7633000700 |
| Mailing Telephone | 6012609830 |
| Enumeration Date | 2019-10-12 |
| Last Update Date | 2019-10-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 903614 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
120 FOUNTAINS BLVD # 1000 |
| City | MADISON |
| State | MS |
| Zip Code | 39110-6343 |
| 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 | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235740556 | Lucille Elizabeth Nathwani | Nurse Practitioner | Uw Medical Foundation 600 Highland Ave, Madison, WI 53792-0001 | 2020-08-11 |
| 1770193419 | Madison Emergency Group, PC | Nurse Practitioner | 1740 Lions Club Rd, Madison, GA 30650-4762 | 2020-08-07 |
| 1376169920 | Brittany Linton | Nurse Practitioner | 149 Fountains Blvd, Madison, MS 39110-6344 | 2020-06-19 |
| 1811517402 | Lillian Teicher Branham | Nurse Practitioner | 382 Slaughter Rd, Madison, AL 35758-2008 | 2020-04-23 |
| 1275179509 | Claire E P Bergman | Nurse Practitioner | 20 S Park St Ste 360, Madison, WI 53715-1387 | 2019-11-21 |
| 1083266779 | Heather Hontzas | Nurse Practitioner | 159 Fountains Blvd Ste A, Madison, MS 39110-6344 | 2019-07-12 |
| 1114404118 | Allison Dyrek | Nurse Practitioner | 20 S Park St Ste 405, Madison, WI 53715-1378 | 2018-07-23 |
| 1851807697 | Kristi M Batchelor | Nurse Practitioner | 20 S Park St Fl 4, Madison, WI 53715 | 2017-12-15 |
| 1366962045 | Katherine Marie Domes | Nurse Practitioner | 5804 Halley Way, Madison, WI 53718-2934 | 2017-06-22 |
| 1750810610 | Marcella Louise Eveler | Nurse Practitioner | University of Wisconsin Hospital 600 Ave, Madison, WI 53792-0001 | 2017-06-05 |
| 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.