Provider Demographics
NPI:1346300423
Name:AMNUEY M CHIEMPRABHA MD PA
Entity Type:Organization
Organization Name:AMNUEY M CHIEMPRABHA MD PA
Other - Org Name:DOCTORS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMNUEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHIEMPRABHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-847-5066
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114
Mailing Address - Country:US
Mailing Address - Phone:601-847-5066
Mailing Address - Fax:601-847-0149
Practice Address - Street 1:820 MANGUM AVE
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114
Practice Address - Country:US
Practice Address - Phone:601-847-5066
Practice Address - Fax:601-847-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08142207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01722227Medicaid
MS01722227Medicaid
MS022945598Medicare PIN