Healthcare Provider Details

I. General information

NPI: 1356312623
Provider Name (Legal Business Name): PRIMARY CARE CLINIC OF RIPLEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/12/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W BANKHEAD ST
NEW ALBANY MS
38652-3319
US

IV. Provider business mailing address

460 W BANKHEAD ST
NEW ALBANY MS
38652-3319
US

V. Phone/Fax

Practice location:
  • Phone: 662-539-7444
  • Fax: 662-837-3760
Mailing address:
  • Phone: 662-539-7444
  • Fax: 662-837-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TROY REUBEN CAPPLEMAN
Title or Position: AO
Credential: MD
Phone: 662-539-7444