1104574847 NPI number — AARON E. HENRY COMMUNITY HEALTH

Table of content: (NPI 1104574847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104574847 NPI number — AARON E. HENRY COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AARON E. HENRY COMMUNITY HEALTH
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:
6
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:
1104574847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSDALE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38614-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-624-4292
Provider Business Mailing Address Fax Number:
662-351-3303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 OHIO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSDALE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38614-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-624-4292
Provider Business Practice Location Address Fax Number:
662-351-3303
Provider Enumeration Date:
03/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
FONDREN
Authorized Official First Name:
CANDACE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
662-624-4292

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09010039 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com