Provider Demographics
NPI:1033346044
Name:NESHOBA URGENT CARE CLINIC
Entity Type:Organization
Organization Name:NESHOBA URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMMUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-663-1423
Mailing Address - Street 1:1003 HOLLAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2180
Mailing Address - Country:US
Mailing Address - Phone:601-663-1423
Mailing Address - Fax:601-663-1474
Practice Address - Street 1:1003 HOLLAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2180
Practice Address - Country:US
Practice Address - Phone:601-663-1423
Practice Address - Fax:601-663-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty