Provider Demographics
NPI:1245420835
Name:CARE PLUS PELAHATCHIE CLINIC
Entity Type:Organization
Organization Name:CARE PLUS PELAHATCHIE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-2102
Mailing Address - Street 1:501 HIGHWAY 80 EAST
Mailing Address - Street 2:
Mailing Address - City:PELAHATCHIE
Mailing Address - State:MS
Mailing Address - Zip Code:39145
Mailing Address - Country:US
Mailing Address - Phone:601-854-8002
Mailing Address - Fax:601-854-7333
Practice Address - Street 1:501 HIGHWAY 80 EAST
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145
Practice Address - Country:US
Practice Address - Phone:601-854-8002
Practice Address - Fax:601-854-7333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER OAKS MANAGEMENT COMPANY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02454Medicare PIN