Organization
INDIANOLA CLINIC, LLC
Active
Parent organization
INDIANOLA CLINIC, LLC
Other names
Leland Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
INDIANOLA CLINIC, LLC
Authorized official
MRS. AMY MCINTIRE (CREDENTIALING)
(662) 686-3956
Entity
Organization
Contact information
Practice address
201 BAKER BLVD, LELAND, MS 38756
(662) 686-4121
(662) 686-4770
Mailing address
201 BAKER BLVD, LELAND, MS 38756
(662) 686-4121
(662) 686-4770
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016086
—
MS
05
—
200005767
—
MS
Enumeration date
09/25/2006
Last updated
09/17/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us