Provider Demographics
NPI:1689680431
Name:CARL C WELCH, MD, PA
Entity Type:Organization
Organization Name:CARL C WELCH, MD, PA
Other - Org Name:TRI-STATE RURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-287-5216
Mailing Address - Street 1:502 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9392
Mailing Address - Country:US
Mailing Address - Phone:662-287-5216
Mailing Address - Fax:662-287-8406
Practice Address - Street 1:502 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9392
Practice Address - Country:US
Practice Address - Phone:662-287-5216
Practice Address - Fax:662-287-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014589Medicaid
MS253964Medicare Oscar/Certification
MS012816367Medicare PIN