Provider Demographics
NPI:1417027921
Name:FIRST CARE FAMILY CLINIC
Entity Type:Organization
Organization Name:FIRST CARE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-620-1496
Mailing Address - Street 1:874 BARNES CROSSING RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0909
Mailing Address - Country:US
Mailing Address - Phone:662-620-1496
Mailing Address - Fax:662-620-6535
Practice Address - Street 1:874 BARNES CROSSING RD
Practice Address - Street 2:SUITE A
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0909
Practice Address - Country:US
Practice Address - Phone:662-620-1496
Practice Address - Fax:662-620-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC02970305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization