Provider Demographics
NPI:1013207091
Name:BAPTIST MEDICAL CLINIC - CONVENIENT CARE
Entity Type:Organization
Organization Name:BAPTIST MEDICAL CLINIC - CONVENIENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CLINIC OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:1151 N STATE ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2407
Mailing Address - Country:US
Mailing Address - Phone:601-292-4261
Mailing Address - Fax:601-292-4262
Practice Address - Street 1:5341 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6173
Practice Address - Country:US
Practice Address - Phone:601-919-2173
Practice Address - Fax:601-919-9723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty