Provider Demographics
NPI:1295493682
Name:INDIAN SPRINGS MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:INDIAN SPRINGS MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JERRID
Authorized Official - Last Name:CUMBERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-782-9997
Mailing Address - Street 1:41 S HALL RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117-8057
Mailing Address - Country:US
Mailing Address - Phone:601-782-9997
Mailing Address - Fax:601-782-5655
Practice Address - Street 1:517 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2552
Practice Address - Country:US
Practice Address - Phone:601-656-1440
Practice Address - Fax:601-782-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center