Provider Demographics
NPI:1225373178
Name:FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER, INC
Other - Org Name:FAMILY HEALTH CENTER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD, FAGOG
Authorized Official - Phone:601-425-3033
Mailing Address - Street 1:PO BOX 4361
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-4361
Mailing Address - Country:US
Mailing Address - Phone:601-425-3033
Mailing Address - Fax:601-422-0431
Practice Address - Street 1:117 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4312
Practice Address - Country:US
Practice Address - Phone:601-425-3033
Practice Address - Fax:601-422-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09010072Medicaid