MEDICARE: VOICE OF CALVARY FAMILY HEALTH CENTER 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	305S00000X	Point of Service	18106	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25-1964	OTHER	MS	FQHC CMS CCN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770525057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOICE OF CALVARY FAMILY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	350 W WOODROW WILSON AVE
Second Line	:	SUITE 615
City	:	JACKSON
State	:	MS
Zip	:	39213-7681
Country	:	US
Telephone Number	:	601-982-0673
Fax Number	:	601-713-2851

Provider Business Practice Location Address
First Line	:	350 W WOODROW WILSON AVE
Second Line	:	SUITE 611
City	:	JACKSON
State	:	MS
Zip	:	39213-7681
Country	:	US
Telephone Number	:	601-713-3233
Fax Number	:	601-713-2851

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	PRIMAUS WHEELER
Credential	:
Telephone Number	:	601-984-8467

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/15/2008

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