Provider Demographics
NPI:1508942244
Name:U-FIRST MEDICAL CLINIC
Entity Type:Organization
Organization Name:U-FIRST MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUWAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SILMON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:601-407-1137
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0283
Mailing Address - Country:US
Mailing Address - Phone:601-407-1137
Mailing Address - Fax:601-407-1134
Practice Address - Street 1:1883 HIGHWAY 43 S STE E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8406
Practice Address - Country:US
Practice Address - Phone:601-407-1137
Practice Address - Fax:601-407-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR688916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS426151235DOtherBLUECROSS BLUESHIELD
MS03630767Medicaid
MSC03762Medicare ID - Type Unspecified
MS426151235DOtherBLUECROSS BLUESHIELD