Provider Demographics
NPI:1477009876
Name:MALLORY COMMUNITY HEALTH
Entity Type:Organization
Organization Name:MALLORY COMMUNITY HEALTH
Other - Org Name:DR. ARENIA C. MALLORY COMMUNITY HEALTH CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:ROZELL
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-834-2566
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-0479
Mailing Address - Country:US
Mailing Address - Phone:662-834-1857
Mailing Address - Fax:662-834-1859
Practice Address - Street 1:14494 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:MS
Practice Address - Zip Code:39063-9627
Practice Address - Country:US
Practice Address - Phone:662-653-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)