Organization
FAMILY HEALTH CARE CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARINA MARIE CLAYTON (CHIEF FINANCIAL OFFICER)
(601) 825-7280
Entity
Organization
Contact information
Practice address
150 J E JOHNSON RD, PRENTISS, MS 39474-3101
(601) 825-7280
(601) 825-8130
Mailing address
PO BOX 24116, JACKSON, MS 39225-4116
(601) 825-7280
(601) 825-8130
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
MS
Enumeration date
10/04/2018
Last updated
10/04/2018
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