1336407394 NPI number — CLAY COUNTY MEDICAL CORPORATION

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 1336407394 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:
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:
1336407394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39773-9320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-495-2300
Provider Business Mailing Address Fax Number:
662-495-2361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 EMERGENCY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39773-9357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-495-2300
Provider Business Practice Location Address Fax Number:
662-495-2361
Provider Enumeration Date:
04/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HAHN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
662-495-2300

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  07375 , 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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