Provider Demographics
NPI:1801047451
Name:PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Entity type:Organization
Organization Name:PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELSTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-840-0196
Mailing Address - Street 1:431 W MAIN ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-3817
Mailing Address - Country:US
Mailing Address - Phone:662-840-0196
Mailing Address - Fax:662-840-0198
Practice Address - Street 1:123 MCCOMB AVE
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2915
Practice Address - Country:US
Practice Address - Phone:601-437-5141
Practice Address - Fax:601-437-3782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTHCARE DEVELOPERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-01
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21276282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
251320Medicare Oscar/Certification