1437404241 NPI number — CAMDEN COMMUNITY FAMILY HEALTH CLINIC, INC.

Table of content: (NPI 1437404241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437404241 NPI number — CAMDEN COMMUNITY FAMILY HEALTH CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMDEN COMMUNITY FAMILY HEALTH CLINIC, 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:
Provider Other Organization Name Type Code:
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:
1437404241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39163-0029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-859-2999
Provider Business Mailing Address Fax Number:
601-859-2999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1493 HIGHWAY 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39045-9524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-859-2999
Provider Business Practice Location Address Fax Number:
601-859-2999
Provider Enumeration Date:
07/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMBERS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER/PRESIDENT
Authorized Official Telephone Number:
601-859-2999

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  R860655 , 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: 500002278 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q74410 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11890942 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03581557 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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