Provider Demographics
NPI:1982634051
Name:NATCHEZ AFTER HOURS CLINIC, P.L.L.C.
Entity Type:Organization
Organization Name:NATCHEZ AFTER HOURS CLINIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-446-7342
Mailing Address - Street 1:PO BOX 18261
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-8261
Mailing Address - Country:US
Mailing Address - Phone:601-442-1900
Mailing Address - Fax:601-442-1908
Practice Address - Street 1:46 SEARGENT PRENTESS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4725
Practice Address - Country:US
Practice Address - Phone:601-442-1900
Practice Address - Fax:601-442-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15913208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty