Organization
INTERNAL MEDICINE CLINIC OF CLARKSDALE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA BLOUNT (OFFICE MANAGER)
(662) 624-5481
Entity
Organization
Contact information
Practice address
1967 HOSPITAL DR, CLARKSDALE, MS 38614-7203
(662) 624-5481
Mailing address
1967 HOSPITAL DR, CLARKSDALE, MS 38614-7203
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16074
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119669
—
MS
05
—
07922048
—
MS
Enumeration date
06/07/2007
Last updated
01/14/2019
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