INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC (NPI# 1235787185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235787185 |
| Entity Type | Organization |
| Organization Name | INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC |
| Practice Address |
2160 E Pass Rd Ste 102 Gulfport MS 39507-3801 |
| Practice Telephone | 2282480561 |
| Mailing Telephone | 2282480561 |
| Mailing Fax Number | 2282480562 |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-04-28 |
| Authorized Official Name | DAVID F ROWE (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 2282480561 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
2160 E PASS RD STE 102 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39507-3801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609389105 | Karen R Burns | Speech-Language Pathologist | 3506 Washington Avenue, Ste E, Gulfport, MS 39507 | 2017-11-07 |
| 1538605027 | Andrea Broussard | Personal Emergency Response Attendant | 406 Pass Rd, Gulfport, MS 39507 | 2017-01-09 |
| 1366872491 | William Alexis Marcia | Pharmacist | 1444 East Pass Road, Gulfport, MS 39507 | 2013-11-27 |
| 1740599380 | Advanced Hearing Systems, Inc. | Hearing Instrument Specialist | 401 Security Square, Gulfport, MS 39507 | 2010-09-30 |
| 1497068118 | Stacey Ritter Carter | Dentist | 1635 East Pass Road, Gulfport, MS 39507 | 2010-07-22 |
| 1477789964 | Letonoff Orthopaedics & Sports | Orthopaedic Surgery | 452 Court House Road, Suite G, Gulfport, MS 39507 | 2009-06-10 |
| 1730385139 | Bernard Frederick Podlin | Dentist | 400 Pass Road, Gulfport, MS 39507 | 2007-06-22 |
| 1043422553 | Mark D Stringer | Dentist | 520-a Courthouse Road, Gulfport, MS 39507 | 2007-05-04 |
| 1154543528 | Pass Road Elementary | Registered Nurse | 37 Pass Road, Gulfport, MS 39507 | 2007-05-03 |
| 1417073768 | John Hough Hopkins | Dentist | 3303 A Ave, Gulfport, MS 39507 | 2007-03-21 |
| Find all providers in zip 39507 | ||||
| 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 |
|---|---|---|---|---|
| 1366952921 | George W Monlux Jr Md Inc | Family Medicine | 4602 27th Ave S, Gulfport, FL 33711-3704 | 2017-10-09 |
| 1790071371 | Joan Marie Gonzalez | Family Medicine | 5501 Marvin Shields Blvd Bldg 295, Gulfport, MS 39501-9007 | 2011-06-22 |
| 1205129137 | Memorial Hospital At Gulfport | Family Medicine | 20006 Hwy 53, 7 Sunshine Place, Gulfport, MS 39503-0000 | 2011-05-25 |
| 1295934115 | Candace Worsham | Family Medicine | 1924 30th Ave, Gulfport, MS 39501-4534 | 2007-07-11 |
| 1982735510 | George Cornelius Moench | Family Medicine | 5702 Gulfport Blvd S, Suite 4, Gulfport, FL 33707-4855 | 2007-03-07 |
| 1730245739 | Paul G Matherne | Family Medicine | 1924 E Pass Rd, Gulfport, MS 39507-3715 | 2006-12-28 |
| 1780755173 | Roger H Reed | Family Medicine | 15444 Dedeaux Rd, Ste. B, Gulfport, MS 39503-2637 | 2006-11-10 |
| 1730268939 | Sean C Kerby | Family Medicine | 12261 Highway 49, Suite 11, Gulfport, MS 39503-2975 | 2006-11-06 |
| 1740365055 | Francisco Camero | Family Medicine | 1202 Broad Ave, Gulfport, MS 39501-2426 | 2006-10-26 |
| 1508949538 | Joseph Daniel Hull | Family Medicine | 15444 Dedeaux Rd Ste B, Gulfport, MS 39503-2637 | 2006-10-23 |
| Find all providers in GULFPORT | ||||
Please comment or provide details below to improve the information on INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI 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.