Provider Demographics
NPI:1386035202
Name:QUICK CARE CLINIC LLC
Entity Type:Organization
Organization Name:QUICK CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-307-2750
Mailing Address - Street 1:350 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4613
Mailing Address - Country:US
Mailing Address - Phone:662-307-2750
Mailing Address - Fax:662-307-2438
Practice Address - Street 1:350 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4613
Practice Address - Country:US
Practice Address - Phone:662-307-2750
Practice Address - Fax:662-307-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care