Provider Demographics
NPI:1639284409
Name:CLAY COUNTY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CORPORATION
Other - Org Name:CLAY COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER EMPLOYEE PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:CROSSWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:662-495-2328
Mailing Address - Street 1:850 EMERGENCY DRIVE
Mailing Address - Street 2:NMMC WEST POINT PHARMACY
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773
Mailing Address - Country:US
Mailing Address - Phone:662-492-3188
Mailing Address - Fax:662-495-2370
Practice Address - Street 1:850 EMERGENCY DRIVE
Practice Address - Street 2:NMMC WEST POINT PHARMACY
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773
Practice Address - Country:US
Practice Address - Phone:662-492-3188
Practice Address - Fax:662-495-2370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY COUNTY MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13-312282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCLA0067NMedicaid
MS0020079Medicaid
TN010773Medicaid
GA300041685AMedicaid
MS000020079OtherBLUE CROSS
SC10272AMedicaid
ALCLA0067NMedicaid