Organization
YALOBUSHA MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINNAMON FOSTER FNP-BC (SOLE MEMBER)
(662) 473-1140
Entity
Organization
Contact information
Practice address
712 S MAIN ST, WATER VALLEY, MS 38965-3334
(662) 473-1140
(662) 473-1138
Mailing address
712 S MAIN ST, WATER VALLEY, MS 38965-3334
(662) 473-1140
(662) 473-1138
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R872547
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659607232
NPI, TYPE 1
—
Enumeration date
07/08/2012
Last updated
04/05/2022
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