Provider Demographics
NPI:1952518300
Name:FAMILY ACUTE CARE CLINIC, INC
Entity Type:Organization
Organization Name:FAMILY ACUTE CARE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-286-5112
Mailing Address - Street 1:123 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9359
Mailing Address - Country:US
Mailing Address - Phone:662-286-5112
Mailing Address - Fax:662-286-6015
Practice Address - Street 1:123 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9359
Practice Address - Country:US
Practice Address - Phone:662-286-5112
Practice Address - Fax:662-286-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR124170261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120901Medicaid
1487701694OtherINDIVIDUAL NPI
MS258950Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
1487701694OtherINDIVIDUAL NPI