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General NPI Number Information
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NPI Number | 1154671584
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Entity Type | Organization
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Legal Business Name | SPEEDY CARE CLINIC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 2422 CHURCH ST
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City | BYHALIA
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State | MS
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Zip | 38611
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Country | US
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Telephone | 662-850-0144
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Fax | 662-850-0161
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Provider Business Mailing Address
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Address Line | 2422 CHURCH ST
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City | BYHALIA
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State | MS
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Zip | 38611
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Country | US
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Telephone | 662-850-0144
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Fax | 662-850-0161
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Authorized Official
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Title or Position | OWNER
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Name | RENITA TALLEY
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Credential |
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Telephone | 901-281-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 1002906
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License Number State | MS
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