1851332373 NPI number — SOUTH CENTRAL CLINICS, INC

Table of content: FERNANDA GABRIELA PRADO LOPEZ ARISTI LMFTA (NPI 1013490184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851332373 NPI number — SOUTH CENTRAL CLINICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL CLINICS, INC
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:
SOUTH CENTRAL EMERGENCY PHYSICIANS
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:
1851332373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39441-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-425-7550
Provider Business Mailing Address Fax Number:
601-399-6281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-4355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-426-4000
Provider Business Practice Location Address Fax Number:
601-399-6281
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC SUPPORT DIRECTOR
Authorized Official Telephone Number:
601-399-6167

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , 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: 09016188 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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