1578744900 NPI number — FAMILY HEALTH CENTER, INC

Table of content: (NPI 1578744900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578744900 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:
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:
1578744900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. 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:
39441-4361
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:
203 BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDERSVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39477-0279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-428-9918
Provider Business Practice Location Address Fax Number:
601-649-5575
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , 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: 09015884 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9015884 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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