Healthcare Provider Details

I. General information

NPI: 1861663643
Provider Name (Legal Business Name): EASY CARE MEDICAL CLINIC,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 E SHILOH RD
CORINTH MS
38834-3727
US

IV. Provider business mailing address

2016 E SHILOH RD
CORINTH MS
38834-3727
US

V. Phone/Fax

Practice location:
  • Phone: 662-665-9073
  • Fax: 662-665-9098
Mailing address:
  • Phone: 662-665-9073
  • Fax: 662-665-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19029
License Number StateMS

VIII. Authorized Official

Name: DR. NEIL BURTON SLOAN
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 662-665-9073