Provider Demographics
NPI:1215206016
Name:FAMILY FIRST CLINIC OF CLARKSDALE, PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST CLINIC OF CLARKSDALE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-1992
Mailing Address - Street 1:1015 LEE DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-3698
Mailing Address - Country:US
Mailing Address - Phone:901-737-1992
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:1015 LEE DR
Practice Address - Street 2:SUITE 13
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-3698
Practice Address - Country:US
Practice Address - Phone:901-737-1992
Practice Address - Fax:901-309-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4258565OtherBLUE CROSS