Organization Name: | EVERGREEN FAMILY MEDICAL CLINIC INC |
NPI Number: | 1689860629 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CYNTHIA JEANESSE RUSHING (CFNP/OWNER) |
Mailing Address: | 4929 Highway 371 S Nettleton |
State: | MS US |
Postal Code: | 388586901 |
Phone Number: | 6629639154 |
Fax Number: | 6629639157 |
NPI Enumeration Date: | 09/24/2007 |
NPI Last Update Date: | 03/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |