1487196515 NPI number — G.A. CARMICHAEL 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 1487196515 NPI number — G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G.A. CARMICHAEL 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:
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:
1487196515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10340 HIGHWAY 433 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTONIA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39040-9416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-859-5213
Provider Business Mailing Address Fax Number:
601-859-8771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10340 HIGHWAY 433 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-755-2518
Provider Business Practice Location Address Fax Number:
601-859-8771
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-859-5213

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: 09207040 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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