Organization
AMY BENJAMIN
Active
Other names
Wheeler Family Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIE TYUS OFFICE MANAGER (OFFICE MANAGER)
(662) 365-0200
Entity
Organization
Contact information
Practice address
618 CR 5031, BOONEVILLE, MS 38829
(662) 365-0200
(662) 365-0199
Mailing address
PO BOX 95, WHEELER, MS 38880-0095
(662) 365-0200
(662) 365-0199
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
R850588
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03904817
—
MS
01
—
04071559
MEDICAID GROUP
—
05
—
04071559
—
MS
01
—
C03567
CLINIC UPIN
—
Enumeration date
10/12/2006
Last updated
07/28/2008
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