Provider Demographics
NPI:1598991697
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 PRIMARY CARE/WOUND CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-321-1155
Mailing Address - Street 1:1301 FIRST STREET EXTENSION
Mailing Address - Street 2:P O BOX 510
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-3436
Mailing Address - Country:US
Mailing Address - Phone:662-247-3121
Mailing Address - Fax:662-247-3170
Practice Address - Street 1:1301 FIRST STREET EXTENSION
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-0000
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:RURAL HEALRHCARE DEVELOPERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-03
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21126261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health