| Church Street Clinic | |
|
500 Ccc Rd Belzoni MS 39038 | |
| (662) 247-3874 | |
| Not Available |
| Full Name | Church Street Clinic |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 500 Ccc Rd, Belzoni, Mississippi |
| Authorized Official Name and Position | Ray Shoemaker (CEO) |
| Authorized Official Contact | 6622473874 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Church Street Clinic 500 Ccc Road Belzoni MS 39038-0510 Ph: (662) 247-3874 | Church Street Clinic 500 Ccc Rd Belzoni MS 39038 Ph: (662) 247-3874 |
| NPI Number | 1366628927 |
|---|---|
| Provider Enumeration Date | 01/14/2008 |
| Last Update Date | 05/29/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366628927 | NPI | - | NPPES |
| 09014821 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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