Organization
FAMILY HEALTH CARE CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARINA MARIE CLAYTON (CHIEF FINANCIAL OFFICER)
(601) 825-7280
Entity
Organization
Contact information
Practice address
102 BLACKMUR DR, WATER VALLEY, MS 38965
(662) 473-2547
Mailing address
PO BOX 24116, JACKSON, MS 39225-4116
(601) 825-7280
(601) 825-8130
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08784312
—
MS
Enumeration date
11/02/2015
Last updated
04/16/2020
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