Organization
SOUTHWEST HEALTH AGENCY FOR RURAL PEOPLE, INC
Active
Other names
Sharp Famity Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN PETTUS (CEO)
(601) 876-4926
Entity
Organization
Contact information
Practice address
501 EAGLE DAY AVE, COLUMBIA, MS 39429-3605
(601) 731-9108
(601) 731-9190
Mailing address
PO BOX 256, COLUMBIA, MS 39429-0256
(601) 731-9108
(601) 731-9190
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015059
—
MS
01
—
231869
MEDICARE
MS
Enumeration date
01/29/2008
Last updated
01/29/2008
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