Organization
WIGGINS PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY FENDER (ADMINISTRATOR)
(601) 947-8181
Entity
Organization
Contact information
Practice address
975 HALL ST, WIGGINS, MS 39577-2107
(601) 528-9119
(601) 528-9193
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 528-9119
(601) 528-9193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MS
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00488801
—
MS
01
—
C03308
MEDICARE CAHABA
MS
Enumeration date
08/14/2006
Last updated
11/07/2019
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