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General NPI Number Information
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NPI Number | 1194276303
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARE CLINIC. LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 07/10/2017
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Provider Practice Location Address
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Address Line | 218 S THOMAS ST
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City | TUPELO
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State | MS
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Zip | 38801-5330
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Country | US
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Telephone | 662-269-3870
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Fax |
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Provider Business Mailing Address
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Address Line | 218 S THOMAS ST
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City | TUPELO
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State | MS
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Zip | 38801-5330
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Country | US
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Telephone | 662-269-3870
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. CYNTHIA KOHLIEM
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Credential |
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Telephone | 662-269-3870
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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 | R875837
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License Number State | MS
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