PSP MEDICAL CLINIC, LLC (NPI# 1033435680) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033435680 |
| Entity Type | Organization |
| Organization Name | PSP MEDICAL CLINIC, LLC |
| Other Organization Name | MADISON CANTON MEDICAL CLINIC |
| Practice Address |
1171 Hart St. Canton MS 39046 |
| Mailing Address |
Po Box 607 Canton MS 39046 |
| Practice Telephone | 6018599888 |
| Practice Fax Number | 6018599966 |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2014-06-16 |
| Authorized Official Name | DR. PARVESH K. GOEL (MD) |
| Authorized Official Telephone | 6018599888 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
15405 | MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Madison Canton Medical Clinic | Doing Business As Name - Organization |
| Magnolia Medical Clinics | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245581370 | Psp Medical Clinic, LLC | Clinic/Center | 1082 Gluckstadt Rd, Madison, MS 39110 | 2012-09-28 |
| 1225320708 | Psp Medical Clinic, LLC | Clinic/Center | 1435 Grand Ave, Yazoo City, MS 39194 | 2011-05-03 |
| Street Address |
1171 HART ST. |
| City | CANTON |
| State | MS |
| Zip Code | 39046 |
| 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 | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609425180 | Wafa A Elhassan Md Pllc | Clinic/Center | 1905 S Haggerty Rd, Canton, MI 48188-2025 | 2019-09-08 |
| 1326435199 | Forever Kids Pediatric Clinic | Clinic/Center | 182 Privatet Road 6413, Canton, TX 75103 | 2015-04-20 |
| 1265834949 | Kcc Health Promotion Services LLC | Clinic/Center | 1821 Maple Park Dr W, Canton, MI 48188-4829 | 2014-09-24 |
| 1982933487 | Atlas Healthcare and Rehab Holly Springs | Clinic/Center | 2945 Holly Springs Pkwy, Canton, GA 30115-7449 | 2009-12-11 |
| 1902088453 | Canton Family Clinic Inc. | Clinic/Center | 120 E Academy St, Canton, MS 39046-4502 | 2007-11-27 |
| 1255413639 | Vibha Vig Md Pa | Clinic/Center | 156 River Oaks Dr, Suite A, Canton, MS 39046-5376 | 2006-10-19 |
| 1235671926 | Canton South Family Healthcare, LLC | Clinic/Center | 4822 Cleveland Ave S, Canton, OH 44707-1034 | 2016-11-11 |
| 1861818460 | Majid M Taj Md Pllc | Clinic/Center | 41750 Michigan Ave, Canton, MI 48188-2679 | 2014-03-07 |
| 1386081529 | Canton Family Medicine and Medical Spa, Pllc | Clinic/Center | 5958 N Canton Center Rd, Suite 200, Canton, MI 48187-2765 | 2013-05-29 |
| 1063736726 | Michael Tirmonia, Do, Inc | Clinic/Center | 1330 Mercy Dr Nw Ste 324, Canton, OH 44708-2625 | 2010-03-23 |
| Find all providers in CANTON | ||||
Please comment or provide details below to improve the information on PSP MEDICAL CLINIC, LLC.
| 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.