Provider Demographics
NPI:1952305815
Name:HICKORY FLAT CLINIC ASSOCIATION INC
Entity Type:Organization
Organization Name:HICKORY FLAT CLINIC ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSON
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-333-6387
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:HICKORY FLAT
Mailing Address - State:MS
Mailing Address - Zip Code:38633-0128
Mailing Address - Country:US
Mailing Address - Phone:662-333-6387
Mailing Address - Fax:662-333-6725
Practice Address - Street 1:250 OAK ST
Practice Address - Street 2:
Practice Address - City:HICKORY FLAT
Practice Address - State:MS
Practice Address - Zip Code:38633-8122
Practice Address - Country:US
Practice Address - Phone:662-333-6387
Practice Address - Fax:662-333-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014193Medicaid
MS09014193Medicaid