PSP MEDICAL CLINIC LLC (NPI# 1932144243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932144243 |
| Entity Type | Organization |
| Organization Name | PSP MEDICAL CLINIC LLC |
| Other Organization Name | MADISON CANTON MEDICAL CLINIC |
| Practice Address |
1171 Hart St Canton MS 39046-4805 |
| Mailing Address |
P.o. Box 607 Canton MS 39157 |
| Practice Telephone | 6018599888 |
| Practice Fax Number | 6018599966 |
| Mailing Telephone | 6018599888 |
| Mailing Fax Number | 6018599966 |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2020-10-29 |
| Authorized Official Name | MRS. NEELAM GOEL (MANAGER) |
| Authorized Official Telephone | 6018599888 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
15405 | MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| MADISON CANTON MEDICAL CLINIC | Doing Business As Name - Organization |
| Magnolia Medical Clinics | Doing Business As Name - Organization |
| Street Address |
1171 HART ST |
| City | CANTON |
| State | MS |
| Zip Code | 39046-4805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548219082 | Parvesh K Goel | Internal Medicine | 1171 Hart St, Canton, MS 39046-4805 | 2006-05-10 |
| 1770143745 | Dewanna Chambliss | Social Worker | 1171 Hart St, Canton, MS 39046-4805 | 2019-06-20 |
| 1215454343 | Ruth A Chong | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2017-08-29 |
| 1326580820 | William Mckinley | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2016-11-15 |
| 1073963187 | Okshoon Scott | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2016-06-20 |
| 1629424221 | Psp Medical Clinic,llc | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2016-05-12 |
| 1477949097 | Tonya H. Quinn | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2015-04-09 |
| 1194076836 | April Lakeshia Lee | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2012-09-20 |
| 1033490552 | Latoya Sojourney | Nurse Practitioner | 1171 Hart St, Canton, MS 39046-4805 | 2011-08-30 |
| 1235369208 | Goel Diagnostic | Clinical Medical Laboratory | 1171 Hart St, Canton, MS 39046-4805 | 2009-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858053 | Pediatric Haven | Skilled Nursing Facility | 112 Westfalen Drive, Canton, MS 39046 | 2019-12-20 |
| 1932743176 | Stacey Elizabeth Aldridge | Social Worker | 210 E Peace Street, Canton, MS 39046 | 2019-10-31 |
| 1881245736 | Mildred Loving | Technician | 323 Shady Lane, Canton, MS 39046 | 2019-09-23 |
| 1295384683 | Betty Bass | Technician | 693 Miggins Road, Canton, MS 39046 | 2019-09-09 |
| 1972081644 | Charles Brayden Jones | Physical Therapist | 276 Nissan Pkwy Ste 400, Canton, MS 39046 | 2018-08-03 |
| 1013436062 | Andrew J Breland | Counselor | 210 E Peace St, Canton, MS 39046 | 2017-09-11 |
| 1801318290 | Mississippi Enjoy Breastfeeding Shalom Resource Center | Clinic/Center | 343 Smith Street, Canton, MS 39046 | 2017-07-07 |
| 1619362977 | Shameca Hudson | Nurse Practitioner | 274 Cobbville Dr E, Canton, MS 39046 | 2015-04-03 |
| 1144644386 | Margaret Reimers Beckwith | Chiropractor | 124 Links Drive, I-103, Canton, MS 39046 | 2014-02-07 |
| 1053753194 | Tanya Linette Calhoun | Nurse Practitioner | 1171 Hart Street, Canton, MS 39046 | 2013-07-17 |
| Find all providers in zip 39046 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1134313083 | Christus Trinity Clinic | Clinic/Center | 18780 Interstate 20, Canton, TX 75103-3593 | 2007-09-04 |
| 1063431575 | Hannibal Regional Healthcare System, Inc | Clinic/Center | 1802 Elm St, Canton, MO 63435-1694 | 2006-07-18 |
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| 1124515515 | Boa Vida Hospital of Aberdeen, Ms, LLC | Clinic/Center | 2200 5th St N, Columbus, MS 39705-2212 | 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.