INDIANOLA CLINIC, LLC (NPI# 1962940908) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962940908 |
| Entity Type | Organization |
| Organization Name | INDIANOLA CLINIC, LLC |
| Other Organization Name | LELAND MEDICAL CLINIC |
| Practice Address |
201 Baker Blvd Leland MS 38756-3401 |
| Practice Telephone | 6626864121 |
| Practice Fax Number | 6626864770 |
| Mailing Telephone | 6626864121 |
| Mailing Fax Number | 6626864770 |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2018-11-14 |
| Authorized Official Name | MRS. AMY MCINTIRE (CREDENTIALING) |
| Authorized Official Telephone | 6626863956 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 224Z00000X | Occupational Therapy Assistant | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225200000X | Physical Therapy Assistant | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00459821 | 05 |
| Other Name | Type Code |
|---|---|
| Leland Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164964565 | Indianola Clinic, LLC | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2016-11-16 |
| 1942758131 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756-3401 | 2016-09-15 |
| 1902906258 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756-3401 | 2006-09-25 |
| 1679673917 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756 | 2006-09-25 |
| Street Address |
201 BAKER BLVD |
| City | LELAND |
| State | MS |
| Zip Code | 38756-3401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134164916 | Heather Lloyd | Nurse Practitioner | 201 Baker Blvd, Leland, MS 38756 | 2006-06-17 |
| 1962043281 | Robdreka Shaw | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2019-10-08 |
| 1366942971 | Nicole Bradley Andrews | Speech-Language Pathologist | 201 Baker Blvd, Leland, MS 38756 | 2018-02-20 |
| 1427565886 | Abbie Sightler Robinson | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2018-01-08 |
| 1174036792 | Carrie Whitt | Speech-Language Pathologist | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-11-06 |
| 1710499447 | Mary Catherine Ruscoe | Speech-Language Pathologist | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-11-03 |
| 1326550468 | Sheena Brown | Counselor | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-10-30 |
| 1326561895 | Nash Burnside | Occupational Therapy Assistant | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-07-17 |
| 1982127445 | Lauren Austin | Physical Therapy Assistant | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-07-17 |
| 1669903001 | Amanda Leigh Suell | Occupational Therapist | 201 Baker Blvd, Leland, MS 38756-3401 | 2017-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447705314 | Elizabeth Bell | Physical Therapist | 28 S. Point Dr., Leland, MS 38756 | 2016-08-22 |
| 1902138050 | Leland School District | Local Education Agency (LEA) | 408 East Fourth Street, Leland, MS 38756 | 2010-01-31 |
| 1275631699 | Mississippi Holistic Hospice Care Inc | Hospice Care, Community Based | 109 East Street, Unit A, Leland, MS 38756 | 2006-09-20 |
| 1104933316 | James M Huoni Sr. | Dentist | 305 No Broad Street, Leland, MS 38756 | 2006-08-24 |
| 1427468073 | Mississippi State Department of Health | Public Health or Welfare | 801 N Broad St, Leland, MS 38756-2546 | 2014-05-05 |
| 1578926655 | Latoyia Cole | In Home Supportive Care | 511 N Main St, Leland, MS 38756-2657 | 2016-04-05 |
| 1548735558 | A & A Infusion & Specialty, LLC | Pharmacy | 125 E 3rd St, Leland, MS 38756-2705 | 2018-10-05 |
| 1699233916 | Cox Healthcare Clinic, LLC | Clinic/Center | 402 E 3rd St, Leland, MS 38756-2712 | 2019-03-05 |
| 1235772070 | Gail M Sims | Pharmacist | 311 N Main St, Leland, MS 38756-2738 | 2019-10-24 |
| 1598235913 | Leland Drug Company, Inc | Pharmacy | 311 N Main St, Leland, MS 38756-2738 | 2018-11-28 |
| Find all providers in zip 38756 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942758131 | Indianola Clinic, LLC | Clinic/Center | 201 Baker Blvd, Leland, MS 38756-3401 | 2016-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487201372 | Caleb Mountain Climbing Wholistic International Center LLC | Clinic/Center | 610 Adeline St Ste 1a, Hattiesburg, MS 39401-3875 | 2019-08-24 |
| 1700440369 | Gentle Hands Healthcare LLC | Clinic/Center | 135 Oak Meadow Dr, Clinton, MS 39056-6044 | 2019-04-29 |
| 1629530795 | A Port In The Storm (apits) | Clinic/Center | 102 N. Cass Street, Suite B, Corinth, MS 38834 | 2019-04-05 |
| 1730502055 | Hancock Medical Health Services | Clinic/Center | 5435 Gex Road, Diamondhead, MS 39525 | 2014-01-22 |
| 1538478870 | Hancock Medical Health Services, Inc. | Clinic/Center | 100 Hancock Square Dr, Bay St Louis, MS 39520-1632 | 2010-10-05 |
| 1629287719 | Singing River Health System | Clinic/Center | 7001 Highway 614, Moss Point, MS 39562 | 2007-05-22 |
| 1164422580 | Mississippi University for Women | Clinic/Center | 620 10th St South, Cromwell Bldg Room 129, Columbus, MS 39701 | 2005-07-28 |
| 1578129177 | Madison Hma LLC | Clinic/Center | 161 River Oaks Dr, Canton, MS 39046-5375 | 2019-05-20 |
| 1902361660 | Sog Physical Therapy | Clinic/Center | 1211 S Gloster St Ste C, Tupelo, MS 38801-6535 | 2019-02-07 |
| 1558897744 | Asa LLC | Clinic/Center | 1924 30th Ave, Gulfport, MS 39501-4534 | 2017-05-07 |
| Find all providers with the same taxonomy | ||||
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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.