MEDICARE: DUTCH MEDICAL CLINICS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215276175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUTCH MEDICAL CLINICS, INC

Provider Business Mailing Address
First Line	:	PO BOX 1447
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39703-1447
Country	:	US
Telephone Number	:	662-570-4770
Fax Number	:	662-570-4724

Provider Business Practice Location Address
First Line	:	3654B NEW HOPE RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-8521
Country	:	US
Telephone Number	:	662-329-1488
Fax Number	:	662-329-1486

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH A GILLIS
Credential	:
Telephone Number	:	662-327-5202

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	09/25/2025

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