Provider Demographics
NPI:1902826951
Name:SENTER MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:SENTER MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-454-7170
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-0549
Mailing Address - Country:US
Mailing Address - Phone:662-454-7170
Mailing Address - Fax:662-454-7177
Practice Address - Street 1:26 THIRD STREET
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MS
Practice Address - Zip Code:38827
Practice Address - Country:US
Practice Address - Phone:662-454-7170
Practice Address - Fax:662-454-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK916OtherMEDICARE GROUP
MSC03327Medicare UPIN