DESOTO FAMILY WELLNESS CENTER, LLC


Address: 3495 Cobblestone Blvd South, Southaven, MS 38672-3867
Phone: 6628922885

DESOTO FAMILY WELLNESS CENTER, LLC (NPI# 1376143024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1376143024
Entity Type Organization
Organization Name DESOTO FAMILY WELLNESS CENTER, LLC
Practice Address 3495 Cobblestone Blvd South
Southaven
MS 38672-3867
Mailing Address 3495 Cobblestone Blvd South
Southaven
MS 38672
Practice Telephone 6628922885
Practice Fax Number 6628922889
Mailing Telephone 6628922885
Mailing Fax Number 6628922889
Enumeration Date 2020-10-30
Last Update Date 2020-10-30
Authorized Official Name AMY OLLAR (BILLING/INSURANCE MANAGER)
Authorized Official Telephone 6628922885
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LP2300X Nurse Practitioner
Specialization: Primary Care
Physician Assistants & Advanced Practice Nursing Providers
Y 207Q00000X Family Medicine Allopathic & Osteopathic Physicians

Office Location

Street Address 3495 COBBLESTONE BLVD SOUTH
City SOUTHAVEN
State MS
Zip Code 38672-3867

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1871100826 Sarah Kathryn Pratt Physical Therapist 5271 Getwell Road, Suite A, Southaven, MS 38672 2020-09-24
1356713606 Deadra Dennis Behavioral Analyst 2816 Calico Rock Cv, Southaven, MS 38672 2015-10-27
1568727352 Patricia Leanne Lewis Family Medicine 5908 Getwell Rd, Southaven, MS 38672 2012-07-09
1417183922 Mississippi Cvs Pharmacy, L.L.C. Durable Medical Equipment & Medical Supplies 2945 Goodman Road East, Southaven, MS 38672 2009-06-10
1568609998 Susan Orsland Physical Therapist 4355 Genevieve Drive, Southaven, MS 38672 2009-01-07
1659516524 Stacy L Sanders Audiologist 5740 Getwell Rd. Building 3 Unit B, Southaven, MS 38672 2008-12-08
1295927226 Tracey F Petrides Family Medicine 5779 Getwell Road, Building D, Suite 3, Southaven, MS 38672 2007-08-14
1538288741 Bruce A Denney Dentist 7125 Getwell Road, Suite 102, Southaven, MS 38672 2007-03-28
1154480150 Kimberly Marie Metcalf Social Worker 7165-g Getwell Rd., Southaven, MS 38672 2006-12-06
1346318441 Deborah Verucchi Nurse Practitioner 5740 Getwell Rd Ste B, Southaven, MS 38672 2006-11-30
Find all providers in zip 38672

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1891352514 Linda A Foster Md PC Family Medicine 7900 Airways Blvd Bldg C1, Southaven, MS 38671-4114 2019-05-29
1568727352 Patricia Leanne Lewis Family Medicine 5908 Getwell Rd, Southaven, MS 38672 2012-07-09
1518270636 Madiha Dar Haji Family Medicine 7736 Airways Boulevard, Southaven, MS 38671 2010-07-18
1982936126 Sunil Malhotra Family Medicine 470 Goodman Rd E, Southaven, MS 38671-9557 2010-02-12
1295927226 Tracey F Petrides Family Medicine 5779 Getwell Road, Building D, Suite 3, Southaven, MS 38672 2007-08-14
1700088085 Kallol Kumar Saha Family Medicine 340 Stateline Rd W, Southaven, MS 38671-1610 2007-05-31
1013039288 Carnahan Clinic Pllc Family Medicine 7900 Airways Blvd Bldg A Ste 6, Southaven, MS 38671-4113 2007-04-06
1083776116 Edward Arnold Steward Family Medicine 1669 Main St Ste A, Southaven, MS 38671-1223 2006-12-14
1093887945 Gary Dwain Carr Family Medicine 5699 Getwell Rd Ste 1, Southaven, MS 38672-7312 2006-11-15
1588743314 Patrick Andrew Ball Family Medicine 7736 Airways Blvd., Southaven, MS 38671-5306 2006-11-03
Find all providers in SOUTHAVEN

Competitor

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City SOUTHAVEN
Zip Code 38672

Improve Information

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Dataset Information

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.

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