Organization
U-FIRST MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUWAYNE L SILMON SR. (OFFICE MANAGER)
(601) 407-1137
Entity
Organization
Contact information
Practice address
1883 HIGHWAY 43 S STE E, CANTON, MS 39046-8406
(601) 407-1137
(601) 407-1134
Mailing address
PO BOX 283, CANTON, MS 39046-0283
(601) 407-1137
(601) 407-1134
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R688916
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03630767
—
MS
01
—
426151235D
BLUECROSS BLUESHIELD
MS
Enumeration date
10/27/2006
Last updated
06/22/2011
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