Healthcare Provider Details

I. General information

NPI: 1396151734
Provider Name (Legal Business Name): COMPREHENSIVE HEALTH SPECIALTY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 HIGHLAND BLVD
NATCHEZ MS
39120-4635
US

IV. Provider business mailing address

329 HIGHLAND BLVD
NATCHEZ MS
39120-4635
US

V. Phone/Fax

Practice location:
  • Phone: 601-445-0740
  • Fax: 601-897-4210
Mailing address:
  • Phone: 601-445-0740
  • Fax: 601-897-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1032011
License Number StateMS

VIII. Authorized Official

Name: LUCINDA BOSWELL DRANE
Title or Position: PRACTICE MANAGER
Credential: FNP-BC
Phone: 601-445-0740