1639284409 NPI number — CLAY COUNTY MEDICAL CORPORATION

Table of content: (NPI 1639284409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639284409 NPI number — CLAY COUNTY MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY COUNTY MEDICAL CORPORATION
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:
CLAY COUNTY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1639284409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 EMERGENCY DRIVE
Provider Second Line Business Mailing Address:
NMMC WEST POINT PHARMACY
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-492-3188
Provider Business Mailing Address Fax Number:
662-495-2370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 EMERGENCY DRIVE
Provider Second Line Business Practice Location Address:
NMMC WEST POINT PHARMACY
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-492-3188
Provider Business Practice Location Address Fax Number:
662-495-2370
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROSSWHITE
Authorized Official First Name:
RONNIE
Authorized Official Middle Name:
JOE
Authorized Official Title or Position:
MANAGER EMPLOYEE PHARMACY
Authorized Official Telephone Number:
662-495-2328

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  13-312 , 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: CLA0067N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0020079 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010773 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300041685A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000020079 . This is a "BLUE CROSS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 10272A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com