1598991697 NPI number — PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC

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 1598991697 NPI number — PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC
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:
PATIENTS CHOICE PRIMARY CARE/WOUND CARE CLINIC
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:
1598991697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 FIRST STREET EXTENSION
Provider Second Line Business Mailing Address:
P O BOX 510
Provider Business Mailing Address City Name:
BELZONI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39038-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-247-3121
Provider Business Mailing Address Fax Number:
662-247-3170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 FIRST STREET EXTENSION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELZONI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39038-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-247-3121
Provider Business Practice Location Address Fax Number:
662-247-3170
Provider Enumeration Date:
06/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHOEMAKER
Authorized Official First Name:
RAY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-321-1155

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  21126 , 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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