Provider Demographics
NPI:1578744900
Name:FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER, INC
Other - Org Name:SANDERSVILLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD, FACOG
Authorized Official - Phone:601-425-3033
Mailing Address - Street 1:P.O. BOX 4361
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-4361
Mailing Address - Country:US
Mailing Address - Phone:601-425-3033
Mailing Address - Fax:601-422-0431
Practice Address - Street 1:203 BROAD STREET
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39477-0279
Practice Address - Country:US
Practice Address - Phone:601-428-9918
Practice Address - Fax:601-649-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015884Medicaid
MS9015884Medicaid
MS9015884Medicaid
MS09015884Medicaid
C00924Medicare UPIN