Organization
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Other names
Holmes Family Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GRIMSLEY (CHIEF FINANCIAL OFFICER)
(601) 815-8732
Entity
Organization
Contact information
Practice address
18295 EMORY ROAD, WEST, MS 39192-0000
(662) 834-1321
(601) 815-6301
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(662) 834-1321
(601) 815-6301
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016279
—
MS
Enumeration date
08/15/2006
Last updated
05/08/2020
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