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General NPI Number Information
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NPI Number | 1093045908
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Entity Type | Organization
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Legal Business Name | IMMEDIATE FAMILY CLINIC
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 12/28/2009
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Provider Practice Location Address
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Address Line | 2490 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-2838
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Country | US
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Telephone | 228-385-3774
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Fax | 228-385-3776
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Provider Business Mailing Address
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Address Line | 2490 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-2838
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Country | US
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Telephone | 228-385-3774
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Fax | 228-385-3776
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Authorized Official
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Title or Position | FNP
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Name | MR. GREG G PARKER
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Credential |
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Telephone | 228-385-3774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | R868142
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | R791344
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License Number State | MS
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