Provider Demographics
NPI:1538310958
Name:PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Entity Type:Organization
Organization Name:PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1807
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-1807
Mailing Address - Country:US
Mailing Address - Phone:662-840-0196
Mailing Address - Fax:662-840-0198
Practice Address - Street 1:123 MCCOMB AVE
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2915
Practice Address - Country:US
Practice Address - Phone:601-437-5141
Practice Address - Fax:601-437-3782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTHCARE DEVELOPERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-03
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS258532Medicare Oscar/Certification