Organization
INDIANOLA CLINIC, LLC
Active
Other names
Leland Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY MCINTIRE (CREDENTIALING)
(662) 686-3956
Entity
Organization
Contact information
Practice address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Mailing address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00459821
—
MS
Enumeration date
02/10/2017
Last updated
11/14/2018
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