Provider Demographics
NPI:1346369519
Name:THE MARION COUNTY INTERNAL MEDICINE CLINIC
Entity Type:Organization
Organization Name:THE MARION COUNTY INTERNAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-736-6443
Mailing Address - Street 1:912 SUMRALL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2652
Mailing Address - Country:US
Mailing Address - Phone:601-736-6443
Mailing Address - Fax:601-736-2543
Practice Address - Street 1:912 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2652
Practice Address - Country:US
Practice Address - Phone:601-736-6443
Practice Address - Fax:601-736-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015343Medicaid
MS09015343Medicaid