| Dr Arenia C Mallory Community Health Center, Inc | |
|
201a Magnolia St Vaiden MS 39176-5644 | |
| (662) 464-5470 | |
| (662) 464-0152 |
| Full Name | Dr Arenia C Mallory Community Health Center, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 201a Magnolia St, Vaiden, Mississippi |
| Authorized Official Name and Position | Dewery Montgomery (INTERIM CEO) |
| Authorized Official Contact | 6628341857 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Arenia C Mallory Community Health Center, Inc Po Box 369 Vaiden MS 39176-0369 Ph: (662) 464-5470 | Dr Arenia C Mallory Community Health Center, Inc 201a Magnolia St Vaiden MS 39176-5644 Ph: (662) 464-5470 |
| NPI Number | 1053439133 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 03/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053439133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Holmes County Family Medicine- Vaiden Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 201a Magnolia St, Vaiden, MS 39176 Phone: 601-496-5400 |