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Organization
LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE
Active
Organization
LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI ESTEP (OFFICE MANAGER)
(601) 267-1400
Entity
Organization
Contact information
Practice address
110 PARK ST, WALNUT GROVE, MS 39189-6526
(601) 267-1400
(601) 253-9464
Mailing address
PO BOX 367, WALNUT GROVE, MS 39189-0367
(601) 267-1400
(601) 253-9464
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05874018
—
MS
Enumeration date
07/22/2008
Last updated
07/22/2008
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