Organization
CLARKSDALE HMA LLC
Active
Other names
Clarksdale Phys Serv ER Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY PARRY ESQ (SR VP AND GENERAL COUNSEL)
(239) 598-3176
Entity
Organization
Contact information
Practice address
1970 HOSPITAL DR, CLARKSDALE, MS 38614-7202
(662) 624-3401
Mailing address
1970 HOSPITAL DR, CLARKSDALE, MS 38614-7202
(662) 624-3401
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000019315
BLUE CROSS
MS
05
—
09014366
—
MS
Enumeration date
07/12/2006
Last updated
03/22/2010
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