Provider Demographics
NPI:1437504719
Name:CLAY COUNTY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CORPORATION
Other - Org Name:WEST POINT PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:REPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3000
Mailing Address - Street 1:328 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-2815
Mailing Address - Country:US
Mailing Address - Phone:662-854-0694
Mailing Address - Fax:662-854-0915
Practice Address - Street 1:328 HIGH ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2815
Practice Address - Country:US
Practice Address - Phone:662-854-0694
Practice Address - Fax:662-854-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL182782OtherALABAMA MEDICAID