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General NPI Number Information
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NPI Number | 1124505912
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Entity Type | Organization
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Legal Business Name | THAXTON FAMILY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 11145 HIGHWAY 6 W
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City | THAXTON
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State | MS
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Zip | 38871-9024
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Country | US
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Telephone | 662-489-8500
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Fax | 662-489-8600
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Provider Business Mailing Address
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Address Line | 11145 HIGHWAY 6 W
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City | THAXTON
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State | MS
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Zip | 38871-9024
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Country | US
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Telephone | 662-489-8500
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Fax | 662-489-8600
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Authorized Official
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Title or Position | PROVIDER/MANAGING MEMBER
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Name | MR. KEVIN FLOYD
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Credential | NP-C
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Telephone | 662-213-7890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 901818
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 901818
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License Number State | MS
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