MEDICARE: MALLORY COMMUNITY HEALTH

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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1881713519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALLORY COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 479
Second Line	:
City	:	LEXINGTON
State	:	MS
Zip	:	39095-0479
Country	:	US
Telephone Number	:	662-834-1857
Fax Number	:	662-834-4937

Provider Business Practice Location Address
First Line	:	9715 HIGHWAY 12 W
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169
Country	:	US
Telephone Number	:	662-235-4731
Fax Number	:	662-235-5255

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. CLYDE ROZELL CHAPMAN II
Credential	:	MD
Telephone Number	:	662-834-1857

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	06/05/2025

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Directions to “MALLORY COMMUNITY HEALTH ” Practice Location

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