Organization
YALOBUSHA GENERAL HOSPITAL
Active
Other names
COFFEEVILLE MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY L VARNER (ADMINISTRATOR)
(662) 473-1411
Entity
Organization
Contact information
Practice address
14430 MAIN ST, COFFEEVILLE, MS 38922-2590
(662) 675-2500
(662) 675-2501
Mailing address
14430 MAIN ST, COFFEEVILLE, MS 38922-2590
(662) 675-2500
(662) 675-2501
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120194
—
MS
05
—
9014717
—
MS
Enumeration date
01/02/2007
Last updated
02/09/2010
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