CHILDRENS CLINIC OF CLARKSDALE PA (NPI# 1497834030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497834030 |
| Entity Type | Organization |
| Organization Name | CHILDRENS CLINIC OF CLARKSDALE PA |
| Practice Address |
2245 N State Street Clarksdale MS 38614 |
| Mailing Address |
Po Box 1447 Clarksdale MS 38614 |
| Practice Telephone | 6626274131 |
| Practice Fax Number | 6626272702 |
| Mailing Telephone | 6626274131 |
| Mailing Fax Number | 6626272702 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. CAROLE L MANGREM (PARTNER) |
| Authorized Official Telephone | 6626274131 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 07191 | MS | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 07070 | MS | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | R861078 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09013997 | 05 |
| Street Address |
2245 N STATE STREET |
| City | CLARKSDALE |
| State | MS |
| Zip Code | 38614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386265627 | Lillie Mae Lockett | Technician | 1025 Ritchie Ave, Clarksdale, MS 38614 | 2020-04-28 |
| 1063957751 | Autospa-healthy Youth Center | Nurse Practitioner | 1202 Desoto Ave, Suite A, Clarksdale, MS 38614 | 2017-01-04 |
| 1700226123 | Nikki Nikkia Cager | Internal Medicine | 785 Ohio Ave Ste 2d, Clarksdale, MS 38614 | 2013-06-29 |
| 1205186947 | Celestial Comfort Care Hospice | Hospice Care, Community Based | 110 Yazoo Ave. Suite 212, Clarksdale, MS 38614 | 2012-09-10 |
| 1063667129 | The Smile Center of Clarksdale | Clinic/Center | 526 Choctaw Street, Suites B & C, Clarksdale, MS 38614 | 2008-11-17 |
| 1801060033 | Clarksdale Municipal School District | Local Education Agency (LEA) | Gycelle Tynes Educational Center, Friars Point Road, Clarksdale, MS 38614 | 2008-04-18 |
| 1184806150 | Mary A Williams | Nurse Practitioner | 125 Highway 322, Clarksdale, MS 38614 | 2007-12-03 |
| 1114040367 | William F Wilson Jr. | Dentist | 850 Desoto Ave, Extended, Clarksdale, MS 38614 | 2007-04-10 |
| 1952434920 | Kathleen Tinnel | Nurse Practitioner | 2245 N State St, Clarksdale, MS 38614 | 2007-03-13 |
| 1497888457 | Carole L Mangrem | Pediatrics | 2245 N Starte St, Clarksdale, MS 38614 | 2007-03-13 |
| Find all providers in zip 38614 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497888457 | Carole L Mangrem | Pediatrics | 2245 N Starte St, Clarksdale, MS 38614 | 2007-03-13 |
| 1295088854 | Dorcas Poni Eshun | Pediatrics | 800 Ohio Ave, Clarksdale, MS 38614-7200 | 2012-10-19 |
| 1770842130 | Aderonke Adefisayo | Pediatrics | 1970 Hospital Dr, Clarksdale, MS 38614-7202 | 2012-05-04 |
| 1710001482 | Peggy J Wells | Pediatrics | 2245 N State St, Clarksdale, MS 38614 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508464181 | Meredith Sanford | Pediatrics | 101 Farm View Dr, Oxford, MS 38655-7728 | 2020-10-15 |
| 1255947297 | Gluckstadt Tc Kids, LLC | Pediatrics | 101 Lexington Dr Ste A, Madison, MS 39110-6986 | 2020-09-16 |
| 1982224895 | Vpa PC | Pediatrics | 111 E Capitol St Ste 215, Jackson, MS 39201-2108 | 2020-04-21 |
| 1992356166 | Marcie P Errington | Pediatrics | 3110 Sumrall Rd, Crystal Springs, MS 39059-8955 | 2019-09-27 |
| 1235635566 | North Mississippi Medcial Center, Inc. | Pediatrics | 1150 S Green St Ste D, Tupelo, MS 38804-4901 | 2018-04-04 |
| 1538675798 | The Pedz Clinic | Pediatrics | 610 3rd St Sw, Magee, MS 39111-3994 | 2017-12-22 |
| 1841715539 | Happicare One LLC Ppec Pediatric Daycare | Pediatrics | 213 W Park Ave, Greenwood, MS 38930-3008 | 2017-08-03 |
| 1336598028 | Andrea Logan Md | Pediatrics | 3631 Bienville Blvd Ste B, Ocean Springs, MS 39564-5702 | 2016-06-03 |
| 1730541640 | Stephanie Harrell | Pediatrics | 309 Llewellyn Ave, Mccomb, MS 39648-2703 | 2016-03-22 |
| 1891179768 | Desoto Children's Clinic - Olive Branch | Pediatrics | 7145 Goodman Road, Olive Branch, MS 38654 | 2015-07-10 |
| Find all providers with the same taxonomy | ||||
| City | CLARKSDALE |
| Zip Code | 38614 |
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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.