MEDICARE: CLAY COUNTY MEDICAL CORPORATION

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	207Q00000X	Family Medicine Physician

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

General Provider Information

NPI Number	:	1437504719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAY COUNTY MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	328 HIGH ST
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-2815
Country	:	US
Telephone Number	:	662-854-0694
Fax Number	:	662-854-0915

Provider Business Practice Location Address
First Line	:	328 HIGH ST
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-2815
Country	:	US
Telephone Number	:	662-854-0694
Fax Number	:	662-854-0915

Authorized Official
Title or Position	:	EXECUTIVE VP
Name	:	JOSEPH REPPERT
Credential	:
Telephone Number	:	662-377-3000

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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Directions to “CLAY COUNTY MEDICAL CORPORATION ” Practice Location

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