| Organization Name: | MOSS POINT FAMILY CLINIC |
| NPI Number: | 1518172568 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM SIDNEY ROBERT ROSS (OWNER) |
| Mailing Address: | 5430 Griffin St Moss Point |
| State: | MS US |
| Postal Code: | 395632003 |
| Phone Number: | 2283550719 |
| Fax Number: | 2284754039 |
| NPI Enumeration Date: | 05/13/2007 |
| NPI Last Update Date: | 05/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 12739 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |