Provider Demographics
NPI:1740278738
Name:CMA FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:CMA FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF SCIENCE
Authorized Official - Phone:601-876-5337
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:P O BOX 424
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2021
Mailing Address - Country:US
Mailing Address - Phone:601-876-5337
Mailing Address - Fax:601-876-5045
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2021
Practice Address - Country:US
Practice Address - Phone:601-876-5337
Practice Address - Fax:601-876-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015286Medicaid
MS09015286Medicaid