Healthcare Provider Details

I. General information

NPI: 1699918326
Provider Name (Legal Business Name): SENTER MEDICAL CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 3RD STREET
BELMONT MS
38827-0549
US

IV. Provider business mailing address

PO BOX 549
BELMONT MS
38827-0549
US

V. Phone/Fax

Practice location:
  • Phone: 662-454-7170
  • Fax: 662-454-7177
Mailing address:
  • Phone: 662-454-7170
  • Fax: 662-454-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11702
License Number StateAL

VIII. Authorized Official

Name: CINDY D GRUBBS
Title or Position: INS COOR
Credential:
Phone: 662-454-7170