| Organization Name: | PEARL RIVER FAMILY CLINIC |
| NPI Number: | 1770715450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL BOLEWARE (ADMINISTRATOR) |
| Mailing Address: | 302 Highway 11 S Poplarville |
| State: | MS US |
| Postal Code: | 394702625 |
| Phone Number: | 6014038284 |
| Fax Number: | 6014038283 |
| NPI Enumeration Date: | 08/14/2009 |
| NPI Last Update Date: | 01/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 21087 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |