| Dr. Arenia C. Mallory Community Health Center, Inc. | |
|
33795 Highway 12 East Durant MS 39063 | |
| (662) 653-0505 | |
| (662) 653-0466 |
| Full Name | Dr. Arenia C. Mallory Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 33795 Highway 12 East, Durant, Mississippi |
| Authorized Official Name and Position | Clyde Rozell Chapman (CHEIF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6628341857 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Arenia C. Mallory Community Health Center, Inc. Po Box 479 Lexington MS 39095-0479 Ph: (662) 834-1857 | Dr. Arenia C. Mallory Community Health Center, Inc. 33795 Highway 12 East Durant MS 39063 Ph: (662) 653-0505 |
| NPI Number | 1902923527 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 07/21/2016 |
| Medicare PECOS PAC ID | 9739074501 |
|---|---|
| Medicare Enrollment ID | O20101123000505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902923527 | NPI | - | NPPES |
| 09016221 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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