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General NPI Number Information
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NPI Number | 1174632889
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Entity Type | Organization
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Legal Business Name | SOUTHWEST CLINIC FOR WOMEN PLLC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 300 RAWLS DRIVE SUITE 900
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone | 601-684-4443
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Fax | 601-684-4491
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Provider Business Mailing Address
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Address Line | PO BOX 848
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City | MCCOMB
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State | MS
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Zip | 39649-0848
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Country | US
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Telephone | 601-684-4443
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Fax | 601-684-4491
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. E J PRICE JR.
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Credential | MD
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Telephone | 601-684-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 05010
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License Number State | MS
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