Provider Demographics
NPI:1285184416
Name:CLAY COUNTY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CORPORATION
Other - Org Name:CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-4228
Mailing Address - Street 1:63 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-0430
Mailing Address - Country:US
Mailing Address - Phone:662-494-1620
Mailing Address - Fax:662-494-0375
Practice Address - Street 1:63 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-0430
Practice Address - Country:US
Practice Address - Phone:662-494-1620
Practice Address - Fax:662-494-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13-312261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS250067Medicare Oscar/Certification