Organization
GREENE COUNTY FAMILY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY FENDER (ADMINISTRATOR)
(601) 947-8181
Entity
Organization
Contact information
Practice address
1017 JACKSON AVE, LEAKESVILLE, MS 39451-9105
(601) 394-2820
(601) 394-2827
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-1332
(601) 947-1331
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
11343
MS
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118573
—
MS
01
—
258544
MEDICARE TRSIPAN
MS
Enumeration date
08/27/2008
Last updated
12/05/2019
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