| Organization Name: | LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE |
| NPI Number: | 1053576819 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTI ESTEP (OFFICE MANAGER) |
| Mailing Address: | 110 Park St Walnut Grove |
| State: | MS US |
| Postal Code: | 391896526 |
| Phone Number: | 6012671400 |
| Fax Number: | 6012539464 |
| NPI Enumeration Date: | 07/22/2008 |
| NPI Last Update Date: | 07/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NR1301X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Rural |
| Taxonomy Definition: | |