| Organization Name: | PRIMARY HEALTH CARE, PLLC |
| NPI Number: | 1104074319 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARTHA MOORE CLINTON (OWNER / OPERATOR) |
| Mailing Address: | 565 N Robinson St Senatobia |
| State: | MS US |
| Postal Code: | 386682118 |
| Phone Number: | 6625604313 |
| Fax Number: | 6625604383 |
| NPI Enumeration Date: | 08/29/2008 |
| NPI Last Update Date: | 09/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | R672491 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |