Organization
PREMIER FAMILY CLINIC & URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELIA TICE F.N.P.B.C. (PROVIDER/MANAGER)
(662) 534-8780
Entity
Organization
Contact information
Practice address
312 PARK PLAZA DR, NEW ALBANY, MS 38652-3104
(662) 213-1225
Mailing address
312 PARK PLAZA DR, NEW ALBANY, MS 38652-3104
(662) 534-8780
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R857901
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255617973
NPIENUMERATOR.COM
MS
Enumeration date
09/10/2012
Last updated
06/18/2013
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