Organization
IUKA TOWN CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY SHAREE TILL (OWNER)
(662) 423-5007
Entity
Organization
Contact information
Practice address
109 E QUITMAN ST, SUITE A, IUKA, MS 38852-1936
(662) 423-5007
(662) 423-5050
Mailing address
109 E QUITMAN ST, SUITE A, IUKA, MS 38852-1936
(662) 423-5007
(662) 423-5050
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
989911
MS
Other
Enumeration date
01/02/2012
Last updated
03/09/2012
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