Provider Demographics
NPI:1356459069
Name:ACUTE CARE & FAMILY CLINIC OF PONTOTOC
Entity Type:Organization
Organization Name:ACUTE CARE & FAMILY CLINIC OF PONTOTOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-534-7777
Mailing Address - Street 1:351 A PEOPLES DR
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-8990
Mailing Address - Country:US
Mailing Address - Phone:662-489-2777
Mailing Address - Fax:662-489-0065
Practice Address - Street 1:351 A PEOPLES DR
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-8990
Practice Address - Country:US
Practice Address - Phone:662-489-2777
Practice Address - Fax:662-489-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty