Provider Demographics
NPI:1073631164
Name:CREEKMORE CLINIC, P.L.L.C.
Entity Type:Organization
Organization Name:CREEKMORE CLINIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CREEKMORE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-534-9042
Mailing Address - Street 1:216 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-9042
Mailing Address - Fax:662-534-9707
Practice Address - Street 1:216 OXFORD ROAD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3115
Practice Address - Country:US
Practice Address - Phone:662-534-9042
Practice Address - Fax:662-534-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty