Healthcare Provider Details

I. General information

NPI: 1851049159
Provider Name (Legal Business Name): TRUEMED CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8727 NORTHWEST DR STE B
SOUTHAVEN MS
38671-2429
US

IV. Provider business mailing address

PO BOX 624
SOUTHAVEN MS
38671-0007
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-6209
  • Fax: 662-342-9922
Mailing address:
  • Phone: 901-489-9212
  • Fax: 662-342-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY B KING
Title or Position: MANAGING MEMBER
Credential:
Phone: 901-489-9212