Organization
WOMEN & PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE PORTER (ACCOUNTS RECEIVABLE COORDINATOR)
(662) 741-2151
Entity
Organization
Contact information
Practice address
1217 E RAILROAD AVE, GREENVILLE, MS 38703-3256
(662) 335-3991
(662) 332-1736
Mailing address
1414 HOSPITAL ST, GREENVILLE, MS 38703-3217
(662) 335-3991
(662) 332-1736
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05438355
—
MS
Enumeration date
08/08/2007
Last updated
08/08/2007
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