Organization
COMMUNITY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN RUTLEDGE (BILLING MANAGER)
(601) 947-1330
Entity
Organization
Contact information
Practice address
92 W RATLIFF STREET, LUCEDALE, MS 39452-6537
(601) 947-8181
(601) 947-4411
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-8181
(601) 947-1331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013891
—
MS
01
—
C00960
MEDICARE CAHABA
MS
01
—
CN0018
RAILROAD MEDICARE/OTHER
MS
Enumeration date
08/08/2006
Last updated
02/04/2020
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