Provider Demographics
NPI:1265646434
Name:D.W. RATLIFF
Entity Type:Organization
Organization Name:D.W. RATLIFF
Other - Org Name:BELMONT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-454-3401
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-0190
Mailing Address - Country:US
Mailing Address - Phone:662-454-3401
Mailing Address - Fax:662-454-3401
Practice Address - Street 1:102 THIRD STREET
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MS
Practice Address - Zip Code:38827-0190
Practice Address - Country:US
Practice Address - Phone:662-454-3401
Practice Address - Fax:662-454-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7354261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016909Medicaid
MS00016909Medicaid
MS082945519Medicare PIN