Provider Demographics
NPI:1689144792
Name:OPEN ARMS CHILDREN'S CLINIC LLC,
Entity Type:Organization
Organization Name:OPEN ARMS CHILDREN'S CLINIC LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREW
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-308-5253
Mailing Address - Street 1:809 N JACKSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2177
Mailing Address - Country:US
Mailing Address - Phone:601-308-5253
Mailing Address - Fax:601-308-5263
Practice Address - Street 1:809 N JACKSON ST STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2177
Practice Address - Country:US
Practice Address - Phone:601-308-5253
Practice Address - Fax:601-308-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty