| Organization Name: | CONVENIENT CARE CLINIC, PLLC |
| NPI Number: | 1851490841 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLI JONES (DIR OF REVENUE) |
| Mailing Address: | 3040 Goodman Rd West Horn Lake |
| State: | MS US |
| Postal Code: | 386372474 |
| Phone Number: | 6625782030 |
| Fax Number: | 6153016550 |
| NPI Enumeration Date: | 09/22/2006 |
| NPI Last Update Date: | 11/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |