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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