Organization Name: | COMPREHENSIVE FAMILY MEDICAL CENTER, INC. |
NPI Number: | 1396014395 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT L SMITH (OWNER) |
Mailing Address: | 3040 Goodman Rd W Horn Lake |
State: | MS US |
Postal Code: | 386371189 |
Phone Number: | 6622803428 |
Fax Number: | 6622801736 |
NPI Enumeration Date: | 12/20/2011 |
NPI Last Update Date: | 12/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A810353 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |