Provider Demographics
NPI:1760965206
Name:HUNTER ASSETS HOLDING LLC
Entity Type:Organization
Organization Name:HUNTER ASSETS HOLDING LLC
Other - Org Name:TLC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRENCHIE
Authorized Official - Middle Name:COTTON
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-427-7101
Mailing Address - Street 1:350 W WOODROW WILSON AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-427-7101
Mailing Address - Fax:601-427-7103
Practice Address - Street 1:1035 W MAYES ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-6100
Practice Address - Country:US
Practice Address - Phone:601-427-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center