# PREMIER MEDICAL CLINIC OF GREENVILLE PC

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

## Provider details

- **NPI number:** 1568800688
- **Authorized official:** MS. KATHERINE COLBERT CPC (BUSINESS MANAGER)
- **Authorized official phone:** (662) 332-8848

## Contact information

- **Practice address:** 1504 HOSPITAL ST, GREENVILLE, MS 38703-3219
- **Practice address phone:** (662) 378-9929
- **Practice address fax:** (662) 378-9926
- **Mailing address:** PO BOX 4577, GREENVILLE, MS 38704-4577
- **Mailing address phone:** (662) 332-8848
- **Mailing address fax:** (662) 332-8854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 14161 | MS | Yes |

## Other

- **Enumeration date:** 06/11/2013
- **Last updated:** 06/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00114839 | — | MS |