Provider Demographics
NPI:1467635177
Name:MCCLATCHY MEDICAL CENTER
Entity Type:Organization
Organization Name:MCCLATCHY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARDEE
Authorized Official - Last Name:MCCLATCHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-893-7878
Mailing Address - Street 1:7235 HACKS CROSS RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4213
Mailing Address - Country:US
Mailing Address - Phone:662-893-7878
Mailing Address - Fax:
Practice Address - Street 1:7235 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-4213
Practice Address - Country:US
Practice Address - Phone:662-893-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB30366Medicare UPIN