IVANCIC PEDIATRIC CLINIC PA (NPI# 1942606256) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942606256 |
| Entity Type | Organization |
| Organization Name | IVANCIC PEDIATRIC CLINIC PA |
| Practice Address |
499 Gloster Creek Vlg Suite H-3 Tupelo MS 38801-4600 |
| Practice Telephone | 6628406026 |
| Practice Fax Number | 6628406030 |
| Mailing Telephone | 6628406026 |
| Mailing Fax Number | 6628406030 |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2019-01-23 |
| Authorized Official Name | MRS. MITZI PARSONS (OFFICE MANAGER) |
| Authorized Official Telephone | 6628406026 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Street Address |
499 GLOSTER CREEK VLG SUITE H-3 |
| City | TUPELO |
| State | MS |
| Zip Code | 38801-4600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407856958 | Clarance Stephen Farmer II | Urology | 499 Gloster Creek Vlg, Suite A1, Tupelo, MS 38801-4600 | 2005-07-27 |
| 1508219221 | Jacob Rowland | Physician Assistant | 499 Gloster Creek Vlg, Suite G1, Tupelo, MS 38801-4600 | 2016-07-18 |
| 1073960308 | Jordan Ward | Licensed Practical Nurse | 499 Gloster Creek Vlg, Tupelo, MS 38801-4600 | 2016-05-17 |
| 1326402660 | Stephanie Denton | Licensed Practical Nurse | 499 Gloster Creek Vlg, Suite A-3, Tupelo, MS 38801-4600 | 2016-04-13 |
| 1679903546 | Northeast Mental Health-mental Retardation Commission | Clinic/Center | 499 Gloster Creek Vlg, Suite A-3, Tupelo, MS 38801-4600 | 2013-11-13 |
| 1063848638 | Jennifer G. Estock | Nurse Practitioner | 499 Gloster Creek Vlg, Suite D-1, Tupelo, MS 38801-4600 | 2013-09-16 |
| 1508193459 | David Benson Sumerford | Nurse Practitioner | 499 Gloster Creek Vlg, Suite D-1, Tupelo, MS 38801-4600 | 2009-11-13 |
| 1114252160 | Katherine Mcduffie | Nurse Practitioner | 499 Gloster Creek Vlg, Suite A-2, Tupelo, MS 38801-4600 | 2009-10-08 |
| 1871736496 | John Russell, IIi, D.m.d. | Dentist | 499 Gloster Creek Vlg, Tupelo, MS 38801-4600 | 2009-04-13 |
| 1427206556 | Janet Richey | Nurse Practitioner | 499 Gloster Creek Vlg, Ste. A-2, Tupelo, MS 38801-4600 | 2008-09-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1003443458 | Nicole Sherice Taylor | Nurse Practitioner | 845 South Gloster Street, Tupelo, MS 38801 | 2020-03-25 |
| 1821556838 | Wilco Healthcare of North Mississippi, Pllc | Point of Service | 1514 Co Rd 41, Tupelo, MS 38801 | 2019-03-08 |
| 1821565235 | Stephanie K Cagle | Nurse Practitioner | 218 S Thomas St Ste 120-121, Tupelo, MS 38801 | 2018-10-24 |
| 1073092326 | Lauren Parrish | Nurse Practitioner | 1573 Medical Park Circle, Tupelo, MS 38801 | 2018-08-08 |
| 1467948687 | North Mississippi Medcial Center, Inc. | Nurse Practitioner | 990 S Madison St Ste 2, Tupelo, MS 38801 | 2018-07-11 |
| 1043700933 | Hooks Diabetes & Medicine Clinic | Non-Pharmacy Dispensing Site | 2610 Traceland Drive, Ste A, Tupelo, MS 38801 | 2018-05-16 |
| 1073035903 | Annette C Riddle | Counselor | 1004 Eisenhower Drive, Tupelo, MS 38801 | 2017-07-12 |
| 1548709678 | Jaime Summers | Nurse Practitioner | 2780 West Jackson St, Tupelo, MS 38801 | 2017-02-22 |
| 1073975611 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 1168 Cross Creek Drive, Tupelo, MS 38801 | 2016-03-23 |
| Find all providers in zip 38801 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194276303 | Compassionate Care Clinic. LLC | Clinic/Center | 218 S Thomas St, Tupelo, MS 38801-5330 | 2016-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477176824 | Crystalcare | Clinic/Center | 3124 N Shiloh Road, Corinth, MS 38834 | 2020-05-20 |
| 1134759780 | Family First Clinic of Hernando, Limited | Clinic/Center | 2416 Mount Pleasant Rd, Hernando, MS 38632-2001 | 2020-01-23 |
| 1720640899 | Home In The Woods Healthcare Clinic, LLC | Clinic/Center | 6572 County Road 514, Itta Bena, MS 38941-2746 | 2019-06-28 |
| 1366003436 | Blackwell's Family Medicine LLC | Clinic/Center | 107 Ball Ave, Tylertown, MS 39667-2101 | 2019-06-27 |
| 1710545488 | Primary and Behavioral Healthcare Services, Pa | Clinic/Center | 717 E. Fortification St., Jackson, MS 39202-2402 | 2019-05-29 |
| 1720559354 | Golden Years Geriatrics Inc. | Clinic/Center | 1233 County Road 108, New Albany, MS 38652-9787 | 2018-12-07 |
| 1316421373 | Children's International, LLC | Clinic/Center | 2003 Wildwood Rd, Picayune, MS 39466-2178 | 2018-09-17 |
| 1124505912 | Thaxton Family Medical Clinic LLC | Clinic/Center | 11145 Highway 6 W, Thaxton, MS 38871-9024 | 2018-07-24 |
| 1316439615 | Quad/med, LLC | Clinic/Center | 1000 Jere St. Pe' Hwy, C/o Ingalls Main Substation, 1st Floor, Pascagoula, MS 39567 | 2018-06-01 |
| 1194215681 | Brooks Medical Clinic | Clinic/Center | 2113 South Tate Street, Corinth, MS 38834 | 2018-05-10 |
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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.