Organization
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Active
Parent organization
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Other names
JCHC School Based Clinic High School
Organization subpart
Yes
Provider details
NPI number
Legal business name
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Authorized official
SHIRLEY A. ELLIS MBA (CEO)
(601) 786-3475
Entity
Organization
Contact information
Practice address
ROUTE 1 BOX 266, FAYETTE, MS 39069
(601) 786-3475
(601) 786-9980
Mailing address
POST OFFICE BOX 98, FAYETTE, MS 39069-5515
(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
—
09015636
—
MS
Enumeration date
04/02/2008
Last updated
12/15/2010
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