SHAW FAMILY MEDICAL
NPI 1750642633
Clinic/Center in Shaw, MS
NPI Status: Active since June 06, 2012
Contact Information
112 W PEELER AVE
SHAW, MS
ZIP 38773
Phone: (662) 754-3301
Fax: (662) 754-3304
- Organization
- Clinic/Center
- Accepts Insurance
- CLIA Number: 25D2042850
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 06-20-2026
About SHAW FAMILY MEDICAL
This page provides the complete NPI Profile along with additional information for Shaw Family Medical, a provider established in Shaw, Mississippi operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1750642633 assigned on June 2012. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 8 years ago. The provider's is doing business as Shaw Family Medical. The authorized official of this NPI record is Nora Gough-davis (Partner)
- NPI
- 1750642633
- Provider Legal Name
- SHAW FAMILY MEDICAL, LLC
- Other Organization Name
- SHAW FAMILY MEDICAL
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 112 W PEELER AVE SHAW, MS 38773
- Location Phone
- (662) 754-3301
- Location Fax
- (662) 754-3304
- Mailing Address
- PO BOX 299 SHAW, MS 38773
- Mailing Phone
- (662) 754-3301
- Mailing Fax
- (662) 754-3304
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-06-2012
- Last Update Date
- 02-22-2017
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze 4 - HMO
- Bronze 8 - HMO
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 8 - HMO
- Silver 1 - HMO
- Silver 1 with Adult Vision Services - HMO
- Silver 12 with First 4 Primary Care Visits Free - HMO
- Silver 8 - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 25D2042850
- Facility Type
- Practitioner Other
- Certificate Effective Date
- June 21, 2024
- Certificate Expiration Date
- June 20, 2026
- Laboratory Director
- NORA GOUGH-DAVIS
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Shaw Family Medical in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 7 | 5 | 0 | 6 | 4 | 2 | 6 | 3 | 3 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 10 | 0 | 12 | 4 | 4 | 6 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 0 + 0 + 1 + 2 + 4 + 4 + 6 + 6 + 24 = 57 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 57 = 3 | 3 | ||||||||
The NPI number 1750642633 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 8 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1023507456 | TERESA WILSON NP Individual | Nurse Practitioner (Adult Health) | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3301 |
| 1912480328 | CLIFTON DEWAYNE REED Individual | Nurse Practitioner (Family) | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3304 |
| 1518428283 | MRS. WILLIE MARY BOLDEN Individual | Nurse Practitioner (Family) | 112 W PEELER AVE SHAW, MS 38773 (662) 745-6638 |
| 1740410661 | NORA CECELIA GOUGH-DAVIS FNP Individual | Nurse Practitioner (Family) | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3301 |
| 1609416544 | MRS. REGINA JONELLE EVANS FNP Individual | Nurse Practitioner (Family) | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3301 |
| 1538774310 | TIFFANY SHERELL NEWELL NP Individual | Nurse Practitioner (Family) | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3301 |
| 1861150401 | KIM DAVIS NP Individual | Family Medicine | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3301 |
| 1598450082 | MRS. SEREKA V WALKER NP Individual | Nurse Practitioner (Family) | 112 W PEELER AVE SHAW, MS 38773 (662) 754-3301 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1750642633, enumerated in the NPI registry as an "organization" on June 06, 2012
The provider is located at 112 W Peeler Ave Shaw, Ms 38773 and the phone number is (662) 754-3301
This medical organization specializes in Clinic/Center with taxonomy code 261Q00000X
The provider might be accepting Accepts: Molina Healthcare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 25D2042850 for a "practitioner other" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing..
This NPI record was last updated on June 06, 2012. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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