Provider Demographics
NPI:1922713544
Name:ONSITE HOUSE CALL CLINIC
Entity Type:Organization
Organization Name:ONSITE HOUSE CALL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-801-2826
Mailing Address - Street 1:40114 GRUBB SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MS
Mailing Address - Zip Code:39746-9616
Mailing Address - Country:US
Mailing Address - Phone:662-356-1511
Mailing Address - Fax:662-356-1711
Practice Address - Street 1:40114 GRUBB SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-9616
Practice Address - Country:US
Practice Address - Phone:662-356-1511
Practice Address - Fax:662-356-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty