Healthcare Provider Details

I. General information

NPI: 1366576902
Provider Name (Legal Business Name): PATIENTS CHOICE MEDICAL CENTER OF HUMPHREYS COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 C C RD
BELZONI MS
39038-3806
US

IV. Provider business mailing address

500 C C RD
BELZONI MS
39038-3806
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-3831
  • Fax: 662-247-4114
Mailing address:
  • Phone: 662-247-3831
  • Fax: 662-247-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ELSTON C KEMP
Title or Position: CEO
Credential:
Phone: 662-840-0196