Provider Demographics
NPI:1326350240
Name:CHOCTAW COUNTY
Entity Type:Organization
Organization Name:CHOCTAW COUNTY
Other - Org Name:CHOCTAW MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:662-285-6329
Mailing Address - Street 1:119 WEST CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:ACKERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39735-0000
Mailing Address - Country:US
Mailing Address - Phone:601-849-1682
Mailing Address - Fax:601-849-1969
Practice Address - Street 1:119 WEST CHERRY STREET
Practice Address - Street 2:
Practice Address - City:ACKERMAN
Practice Address - State:MS
Practice Address - Zip Code:39735-0000
Practice Address - Country:US
Practice Address - Phone:601-849-1682
Practice Address - Fax:601-849-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center