Provider Demographics
NPI:1003978388
Name:COGGINS FAMILY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:COGGINS FAMILY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:T
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:662-494-5863
Mailing Address - Street 1:411 GRIFFIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-0000
Mailing Address - Country:US
Mailing Address - Phone:662-494-5863
Mailing Address - Fax:662-494-5287
Practice Address - Street 1:411 GRIFFIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-0000
Practice Address - Country:US
Practice Address - Phone:662-494-5863
Practice Address - Fax:662-494-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06521742Medicaid
MS06521742Medicaid