Organization Name: | GLUCKSTADT SPECIAL CARE CLINIC |
NPI Number: | 1003191867 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KAREN M CONNER (DIRECTOR OF CLIENT SOLUTIONS) |
Mailing Address: | 1716 Highway 51 Ste M Madison |
State: | MS US |
Postal Code: | 391105020 |
Phone Number: | 6017075621 |
Fax Number: | 6017079052 |
NPI Enumeration Date: | 10/12/2011 |
NPI Last Update Date: | 10/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |