Healthcare Provider Details

I. General information

NPI: 1841435096
Provider Name (Legal Business Name): PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MCCOMB AVE
PORT GIBSON MS
39150-2915
US

IV. Provider business mailing address

123 MCCOMB AVE
PORT GIBSON MS
39150-2915
US

V. Phone/Fax

Practice location:
  • Phone: 601-437-5141
  • Fax: 601-437-3782
Mailing address:
  • Phone: 601-437-5141
  • Fax: 601-437-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELSTON C KEMP
Title or Position: CEO
Credential:
Phone: 662-840-0196