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General NPI Number Information
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NPI Number | 1558480491
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Entity Type | Organization
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Legal Business Name | CLAIB CTY HSP PRO FEES
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 123 MCCOMB AVE
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City | PORT GIBSON
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State | MS
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Zip | 39150-2915
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Country | US
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Telephone | 601-437-5141
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Fax | 601-437-8547
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Provider Business Mailing Address
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Address Line | 123 MCCOMB AVE P O BOX 1004
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City | PORT GIBSON
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State | MS
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Zip | 39150-2915
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Country | US
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Telephone | 601-437-5141
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Fax | 601-437-8547
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Authorized Official
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Title or Position | CEO
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Name | RAY L SHOEMAKER
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Credential |
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Telephone | 662-321-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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