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NPI Code Detail

MEDICARE: FOREST FAMILY PRACTICE CLINIC PA

MEDICARE: FOREST FAMILY PRACTICE CLINIC PA
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
1207Q00000XFamily Medicine Physician05638MS

Other Identifiers

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

General Provider Information

NPI Number : 1235119181
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOREST FAMILY PRACTICE CLINIC PA
Provider Business Mailing Address
First Line : PO BOX 600
Second Line :
City : FOREST
State : MS
Zip : 39074-0600
Country : US
Telephone Number : 601-469-4861
Fax Number : 601-469-4828
Provider Business Practice Location Address
First Line : 1 MEDICAL LN
Second Line :
City : FOREST
State : MS
Zip : 39074-4039
Country : US
Telephone Number : 601-469-4861
Fax Number : 601-469-4828
Authorized Official
Title or Position : PRESIDENT
Name : JOHN PAUL LEE
Credential : M.D.
Telephone Number : 601-469-4861
Provider Enumeration Date : 01/18/2006
Last Update Date : 10/22/2008

Similar Medicare Providers

1891896510 — AUSTIN ARCHIE HOWARD JR. M.D.
Practice Location Address:
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Practice Phone: 601-469-4861
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1992806699 — JOHN PAUL LEE M.D.
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1346341054 — WILLIAM MARK LEWIS M.D.
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1386745032 — LLH LABS
Practice Location Address:
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1649761685 — INDEPENDENT HEALTHCARE MANAGEMENT, INC
Practice Location Address:
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Practice Fax:
1649762253 — ROBIN SULLIVAN HARDIN NP
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Directions to “FOREST FAMILY PRACTICE CLINIC PA ” Practice Location

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