1154502979 NPI number — FAMILY HEALTH CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154502979 NPI number — FAMILY HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTER, 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:
FAMILY HEALTH CENTER/TAYLORSVILLE
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:
1154502979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4361
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:
39440-4361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-425-3033
Provider Business Mailing Address Fax Number:
601-422-0431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 WILLIS STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-785-9580
Provider Business Practice Location Address Fax Number:
601-785-9910
Provider Enumeration Date:
11/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
RASHAD
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
EXCUTIVE DIRECTOR
Authorized Official Telephone Number:
601-425-3033

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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)





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