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General NPI Number Information
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NPI Number | 1407231541
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 5040 CLINTON BLVD
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City | JACKSON
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State | MS
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Zip | 39209-3262
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Country | US
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Telephone | 769-823-6516
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Fax |
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Provider Business Mailing Address
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Address Line | POST OFFIECE BOX 11233
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City | JACKSON
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State | MS
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Zip | 39283
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Country | US
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Telephone | 769-823-6516
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICKIE DANETTE MYERS BUCHANAN
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Credential |
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Telephone | 769-823-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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