Organization
KILMICHAEL CLINIC
Active
Other names
Kilmichael Hospital Kilmichael Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALVIN DEXTER JOHNSON SR. MHA (ADMINISTRATOR)
(662) 262-4311
Entity
Organization
Contact information
Practice address
303 LAMAR AVENUE, KILMICHAEL, MS 39747
(662) 262-4284
Mailing address
303 LAMAR AVENUE, P.O. BOX 186, KILMICHAEL, MS 39747
(662) 262-4284
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02621525
—
MS
Enumeration date
02/14/2007
Last updated
05/13/2008
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