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General NPI Number Information
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NPI Number | 1174528616
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Entity Type | Organization
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Legal Business Name | HOLLANDALE PRIMARY CARE, INC.
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1257 HWY 61 SOUTH
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City | HOLLANDALE
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State | MS
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Zip | 38748
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Country | US
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Telephone | 662-827-2214
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Fax | 662-827-5019
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | HOLLANDALE
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State | MS
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Zip | 38748-0247
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Country | US
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Telephone | 662-827-2214
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Fax | 662-827-5019
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Authorized Official
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Title or Position | MANAGING ADMINISTRATOR
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Name | MRS. LELA PERKINS
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Credential |
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Telephone | 662-827-7568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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