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General NPI Number Information
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NPI Number | 1497186985
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Entity Type | Organization
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Legal Business Name | TABORIAN URGENT CARE CENTER PROJECT INC.
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 101 N. EDWARDS AVENUE
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City | MOUND BAYOU
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State | MS
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Zip | 38762-9594
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Country | US
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Telephone | 662-741-3222
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Fax | 662-741-3022
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Provider Business Mailing Address
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Address Line | PO BOX 73
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City | MOUND BAYOU
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State | MS
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Zip | 38762-0073
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Country | US
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Telephone | 662-741-3222
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Fax | 662-741-3022
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARGO BROOKS
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Credential |
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Telephone | 662-741-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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