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General NPI Number Information
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NPI Number | 1194968982
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Entity Type | Organization
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Legal Business Name | CLAIBORNE COUNTY FAMILY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 2045 HIGHWAY 61 N
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City | PORT GIBSON
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State | MS
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Zip | 39150-4262
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Country | US
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Telephone | 601-437-3049
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Fax | 601-437-3051
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Provider Business Mailing Address
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Address Line | PO BOX 741
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City | PORT GIBSON
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State | MS
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Zip | 39150-0741
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Country | US
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Telephone | 601-437-3049
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Fax | 601-437-3051
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CONEY L JOHNSON
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Credential |
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Telephone | 601-437-3052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | MS
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