Provider Demographics
NPI:1780817338
Name:FAMILY HEALTH CARE CLINIC, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPA
Authorized Official - Phone:601-825-7280
Mailing Address - Street 1:PO BOX 24116
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4116
Mailing Address - Country:US
Mailing Address - Phone:601-825-7280
Mailing Address - Fax:601-825-8130
Practice Address - Street 1:381 OLD WILLIAMSBURG ROAD
Practice Address - Street 2:
Practice Address - City:BASSFIELD
Practice Address - State:MS
Practice Address - Zip Code:39421-0000
Practice Address - Country:US
Practice Address - Phone:601-825-7280
Practice Address - Fax:601-825-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)