| Organization Name: | PSP MEDICAL CLINIC, LLC |
| NPI Number: | 1225320708 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PARVESH K. GOEL (MD) |
| Mailing Address: | 1435 Grand Ave Yazoo City |
| State: | MS US |
| Postal Code: | 39194 |
| Phone Number: | 6627463555 |
| Fax Number: | 6627465211 |
| NPI Enumeration Date: | 05/03/2011 |
| NPI Last Update Date: | 06/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 15405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |