# CLAIB CTY HSP PRO FEES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558480491
- **Authorized official:** RAY L SHOEMAKER (CEO)
- **Authorized official phone:** (662) 321-1155

## Contact information

- **Practice address:** 123 MCCOMB AVE, PORT GIBSON, MS 39150-2915
- **Practice address phone:** (601) 437-5141
- **Practice address fax:** (601) 437-8547
- **Mailing address:** 123 MCCOMB AVE, P O BOX 1004, PORT GIBSON, MS 39150-2915
- **Mailing address phone:** (601) 437-5141
- **Mailing address fax:** (601) 437-8547

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 06/14/2010