Organization
LINE STREET MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIERRA CAIN (FNP-C/OWNER)
(601) 562-6707
Entity
Organization
Contact information
Practice address
562 LINE ST S BLDG A, PHILADELPHIA, MS 39350-2144
(601) 389-8223
(833) 640-0468
Mailing address
562 LINE ST S BLDG A, PHILADELPHIA, MS 39350-2144
(601) 389-8223
(833) 640-0468
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01805219
—
MS
Enumeration date
06/27/2022
Last updated
06/27/2022
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