1508942244 NPI number — U-FIRST MEDICAL CLINIC

Table of content: (NPI 1508942244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508942244 NPI number — U-FIRST MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U-FIRST MEDICAL CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508942244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39046-0283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-407-1137
Provider Business Mailing Address Fax Number:
601-407-1134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1883 HIGHWAY 43 S STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39046-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-407-1137
Provider Business Practice Location Address Fax Number:
601-407-1134
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SILMON
Authorized Official First Name:
JUWAYNE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
601-407-1137

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R688916 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 426151235D . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 03630767 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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