Healthcare Provider Details

I. General information

NPI: 1992946263
Provider Name (Legal Business Name): THE MYERS FOUNDATION CHRISTIAN FAMILY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15548 HWY. 49 EAST SUITE A
TCHULA MS
39169
US

IV. Provider business mailing address

PO BOX 637
TCHULA MS
39169-0637
US

V. Phone/Fax

Practice location:
  • Phone: 662-235-4227
  • Fax: 662-247-4767
Mailing address:
  • Phone: 662-235-4227
  • Fax: 662-247-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11615
License Number StateMS

VIII. Authorized Official

Name: DR. RONALD V MYERS SR.
Title or Position: FOUNDER/PRESIDENT
Credential: M.D.
Phone: 662-235-4227