Provider Demographics
NPI:1033169545
Name:MANTACHIE RURAL HEALTH CARE, INC
Entity Type:Organization
Organization Name:MANTACHIE RURAL HEALTH CARE, INC
Other - Org Name:MANTACHIE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:T
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-282-4226
Mailing Address - Street 1:5681 HIGHWAY 363
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-7632
Mailing Address - Country:US
Mailing Address - Phone:662-282-4226
Mailing Address - Fax:662-282-7946
Practice Address - Street 1:5681 HIGHWAY 363
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-7632
Practice Address - Country:US
Practice Address - Phone:662-282-4226
Practice Address - Fax:662-282-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014269Medicaid
MS251852Medicare Oscar/Certification