Provider Demographics
NPI:1487833562
Name:PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC
Entity Type:Organization
Organization Name:PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC
Other - Org Name:PATIENTS CHOICE CLINIC OF BELZONI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELSTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-840-0196
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-0510
Mailing Address - Country:US
Mailing Address - Phone:662-247-3121
Mailing Address - Fax:662-247-3170
Practice Address - Street 1:1301 E FIRST ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3436
Practice Address - Country:US
Practice Address - Phone:662-247-3121
Practice Address - Fax:662-247-3170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS258553Medicare PIN
MS253455Medicare PIN