Healthcare Provider Details

I. General information

NPI: 1255043493
Provider Name (Legal Business Name): EUDORA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8995 W COMMERCE ST STE 4
HERNANDO MS
38632-6812
US

IV. Provider business mailing address

8995 W COMMERCE ST STE 4
HERNANDO MS
38632-6812
US

V. Phone/Fax

Practice location:
  • Phone: 662-589-6290
  • Fax: 662-649-6085
Mailing address:
  • Phone: 662-589-6290
  • Fax: 662-649-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY M. PERKINS
Title or Position: OWNER
Credential: FNP-C
Phone: 662-589-6290