Healthcare Provider Details

I. General information

NPI: 1679652754
Provider Name (Legal Business Name): EMMANUEL RIDGE COMMUNITY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 HIGHWAY 49 S SUITE A
FLORENCE MS
39073-9422
US

IV. Provider business mailing address

2073 HIGHWAY 49 S SUITE A
FLORENCE MS
39073-9422
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-3301
  • Fax: 601-709-3308
Mailing address:
  • Phone: 601-709-3301
  • Fax: 601-709-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BEATRICE A EZEM
Title or Position: PRESIDENT/CEO
Credential: RN, CM, CLNC
Phone: 601-927-9839