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General NPI Number Information
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NPI Number | 1255043493
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Entity Type | Organization
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Legal Business Name | EUDORA MEDICAL CENTER LLC
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 8995 W COMMERCE ST STE 4
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City | HERNANDO
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State | MS
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Zip | 38632-6812
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Country | US
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Telephone | 662-589-6290
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Fax | 662-649-6085
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Provider Business Mailing Address
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Address Line | 8995 W COMMERCE ST STE 4
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City | HERNANDO
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State | MS
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Zip | 38632-6812
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Country | US
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Telephone | 662-589-6290
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Fax | 662-649-6085
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMY M. PERKINS
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Credential | FNP-C
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Telephone | 662-589-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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