Provider Demographics
NPI:1700086212
Name:NATCHEZ REGIONAL MEDICAL CLINIC
Entity Type:Organization
Organization Name:NATCHEZ REGIONAL MEDICAL CLINIC
Other - Org Name:NATCHEZ REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-446-6068
Mailing Address - Street 1:P O BOX 14149
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898
Mailing Address - Country:US
Mailing Address - Phone:601-442-6500
Mailing Address - Fax:601-442-1509
Practice Address - Street 1:46 SEARGENT PRENTISS DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-442-6500
Practice Address - Fax:601-442-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02567OtherMEDICARE GROUP