Provider Demographics
NPI:1942536552
Name:DURANT PRIMARY CARE CLINIC
Entity Type:Organization
Organization Name:DURANT PRIMARY CARE CLINIC
Other - Org Name:LEXINGTON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-834-1961
Mailing Address - Street 1:22741 HWY 12 BOWLING GREEN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095
Mailing Address - Country:US
Mailing Address - Phone:662-834-1961
Mailing Address - Fax:662-834-1962
Practice Address - Street 1:22741 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095
Practice Address - Country:US
Practice Address - Phone:662-834-1961
Practice Address - Fax:662-834-1962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURANT PRIMARY CARE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-02
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14192261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115622Medicaid