| Friends Of Children State Line | |
|
82 Church Street State Line MS 39451 | |
| (601) 848-7650 | |
| Not Available |
| Full Name | Friends Of Children State Line |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 82 Church Street, State Line, Mississippi |
| Authorized Official Name and Position | Joe Dawsey (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6013942381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Friends Of Children State Line P O Box 160 Leakesville MS 39451-0160 Ph: () - | Friends Of Children State Line 82 Church Street State Line MS 39451 Ph: (601) 848-7650 |
| NPI Number | 1902031123 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 05/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902031123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |
Coastal Family Health Center, Inc -state Line Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 256 Main St, State Line, MS 39362 Phone: 601-848-7912 Fax: 601-848-7461 |