Organization
CHOCTAW REGIONAL MEDICAL CENTER
Active
Other names
Louisville Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HOLLINGSWORTH WELLS (ADMINISTRATOR)
(662) 285-9460
Entity
Organization
Contact information
Practice address
14724 HIGHWAY 15 N, LOUISVILLE, MS 39339-6318
(662) 773-7500
Mailing address
8613 MS HIGHWAY 12, ACKERMAN, MS 39735-8917
(662) 285-9460
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01771892
—
MS
Enumeration date
04/08/2015
Last updated
04/20/2022
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