Healthcare Provider Details

I. General information

NPI: 1770525057
Provider Name (Legal Business Name): VOICE OF CALVARY FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WOODROW WILSON AVE SUITE 611
JACKSON MS
39213-7681
US

IV. Provider business mailing address

350 W WOODROW WILSON AVE SUITE 615
JACKSON MS
39213-7681
US

V. Phone/Fax

Practice location:
  • Phone: 601-713-3233
  • Fax: 601-713-2851
Mailing address:
  • Phone: 601-982-0673
  • Fax: 601-713-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number18106
License Number StateMS

VIII. Authorized Official

Name: PRIMAUS WHEELER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-984-8467