Organization
PRIMARY HEALTH CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARTHA MOORE CLINTON FNP-BC (OWNER / OPERATOR)
(662) 560-4313
Entity
Organization
Contact information
Practice address
565 N ROBINSON ST, SENATOBIA, MS 38668-2118
(662) 560-4313
(662) 560-4383
Mailing address
565 N ROBINSON ST, SENATOBIA, MS 38668-2118
(662) 560-4313
(662) 560-4383
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
R672491
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116700
—
MS
01
—
11618104
CAQH
MS
01
—
R672491
LICENSE NUMBER
MS
01
—
S19627
UPIN
MS
Enumeration date
08/29/2008
Last updated
03/07/2023
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