Provider Demographics
NPI:1932409323
Name:SENATOBIA FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:SENATOBIA FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FORSTER
Authorized Official - Middle Name:GEHRING
Authorized Official - Last Name:RUHL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-562-0411
Mailing Address - Street 1:104 N ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2149
Mailing Address - Country:US
Mailing Address - Phone:662-562-0411
Mailing Address - Fax:662-560-0161
Practice Address - Street 1:104 N ROBINSON ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2149
Practice Address - Country:US
Practice Address - Phone:662-562-0411
Practice Address - Fax:662-560-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty