Organization
WATER VALLEY RURAL HEALTH PAUL ODOM MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL LEROY ODOM MD (OWNER)
(662) 473-1311
Entity
Organization
Contact information
Practice address
645 SOUTH MAIN STREET, WATER VALLEY, MS 38965
(662) 473-1311
(662) 473-2489
Mailing address
PO BOX 725, 645 S MAIN STREET, WATER VALLEY, MS 38965
(662) 473-1311
(662) 473-2489
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013597
—
MS
01
—
253848
MEDICARE RIVERBEND
—
Enumeration date
11/16/2006
Last updated
08/22/2020
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