Organization
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Active
Parent organization
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Authorized official
SHIRLEY A. ELLIS (CEO)
(601) 786-3475
Entity
Organization
Contact information
Practice address
468 HIGHWAY 33, FAYETTE, MS 39069-4546
(601) 786-3475
(601) 786-9980
Mailing address
PO BOX 98, FAYETTE, MS 39069-0098
(601) 786-3475
(601) 786-9980
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015637
—
MS
Enumeration date
04/02/2008
Last updated
06/20/2008
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