Provider Demographics
NPI:1649736950
Name:THE FREE CLINIC OF MERIDIAN, INC.
Entity Type:Organization
Organization Name:THE FREE CLINIC OF MERIDIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-286-5551
Mailing Address - Street 1:PO BOX 3924
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39303-3924
Mailing Address - Country:US
Mailing Address - Phone:601-286-5551
Mailing Address - Fax:601-286-5548
Practice Address - Street 1:4707 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2622
Practice Address - Country:US
Practice Address - Phone:601-286-5551
Practice Address - Fax:601-286-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty