Provider Demographics
NPI:1851851042
Name:1ST CARE MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:1ST CARE MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-213-5078
Mailing Address - Street 1:291 DOC WOODY RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-3501
Mailing Address - Country:US
Mailing Address - Phone:662-213-5078
Mailing Address - Fax:
Practice Address - Street 1:223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2123
Practice Address - Country:US
Practice Address - Phone:662-213-5078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty