Healthcare Provider Details

I. General information

NPI: 1205180882
Provider Name (Legal Business Name): CAIN CLINIC OF EUPORA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 VETERANS MEMORIAL BLVD
EUPORA MS
39744-2023
US

IV. Provider business mailing address

1700 VETERANS MEMORIAL BLVD
EUPORA MS
39744-2023
US

V. Phone/Fax

Practice location:
  • Phone: 662-258-7533
  • Fax: 662-258-7534
Mailing address:
  • Phone: 662-258-7533
  • Fax: 662-258-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN D MCCOY
Title or Position: OWNER
Credential: MD
Phone: 662-258-7533