Provider Demographics
NPI:1639684152
Name:CLAY COUNTY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CORPORATION
Other - Org Name:NORTH MISSISSIPPI SURGERY CLINIC EUPORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:HALLMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-5186
Mailing Address - Street 1:450 E PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5599
Mailing Address - Country:US
Mailing Address - Phone:662-377-4685
Mailing Address - Fax:662-377-2057
Practice Address - Street 1:70 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744-4018
Practice Address - Country:US
Practice Address - Phone:662-258-9400
Practice Address - Fax:662-258-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty