Healthcare Provider Details

I. General information

NPI: 1427098003
Provider Name (Legal Business Name): SOUTH CENTRAL CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 AVE B SUITE 200
ELLISVILLE MS
39437
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-477-3550
  • Fax: 601-477-2236
Mailing address:
  • Phone: 601-425-7550
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number253437
License Number StateMS

VIII. Authorized Official

Name: MRS. MONICA MORROW
Title or Position: DIRECTOR CLINIC SUPPORT
Credential:
Phone: 601-399-6167