Provider Demographics
NPI:1083767271
Name:ABERDEEN HEALTH CLINIC INC
Entity Type:Organization
Organization Name:ABERDEEN HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-369-6131
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:501 CHESTNUT STREET
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730
Mailing Address - Country:US
Mailing Address - Phone:662-369-6131
Mailing Address - Fax:662-369-4588
Practice Address - Street 1:501 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730
Practice Address - Country:US
Practice Address - Phone:662-369-6131
Practice Address - Fax:662-369-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8243207R00000X
MSR857916208D00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC20194OtherMEDICARE PART B
MS09014086Medicaid
C47972Medicare UPIN
MSC20194OtherMEDICARE PART B