Organization
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY ELLIS-STAMPLEY (CEO)
(601) 786-3475
Entity
Organization
Contact information
Practice address
225 COMMUNITY DR, POST OFFICE BOX 98, FAYETTE, MS 39069-0098
(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
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09010057
—
MS
Enumeration date
08/20/2006
Last updated
12/29/2010
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