Provider Demographics
NPI:1770696213
Name:YAZOO FAMILY HEALTHCARE,LLC
Entity type:Organization
Organization Name:YAZOO FAMILY HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-746-2113
Mailing Address - Street 1:307 E FIFTEENTH ST
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2631
Mailing Address - Country:US
Mailing Address - Phone:662-746-2113
Mailing Address - Fax:662-746-2115
Practice Address - Street 1:307 E FIFTEENTH ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2631
Practice Address - Country:US
Practice Address - Phone:662-746-2113
Practice Address - Fax:662-746-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS425460633BOtherBLUE CROSS BLUE SHIELD
MS03278771Medicaid
MS587229770AOtherBLUE CROSS BLUE SHIELD
MS00124725Medicaid
MS587571939OtherBLUE CROSS BLUE SHIELD
MS0011803Medicaid
MS00126250Medicaid
MS00124725Medicaid
MS0011803Medicaid
MSP64043Medicare UPIN
MS03278771Medicaid
MS587571939OtherBLUE CROSS BLUE SHIELD
MS258969Medicare Oscar/Certification
MSP43297Medicare UPIN
MSS10713Medicare UPIN
500001380Medicare ID - Type Unspecified