Provider Demographics
NPI:1437404241
Name:CAMDEN COMMUNITY FAMILY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:CAMDEN COMMUNITY FAMILY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-859-2999
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MS
Mailing Address - Zip Code:39163-0029
Mailing Address - Country:US
Mailing Address - Phone:601-859-2999
Mailing Address - Fax:601-859-2999
Practice Address - Street 1:1493 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:MS
Practice Address - Zip Code:39045-9524
Practice Address - Country:US
Practice Address - Phone:601-859-2999
Practice Address - Fax:601-859-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860655261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
500002278OtherMEDICARE
Q74410OtherUPIN
11890942OtherCAQH
MS03581557Medicaid