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General NPI Number Information
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NPI Number | 1598904377
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Entity Type | Organization
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Legal Business Name | HL CAMPBELL RURAL HEALTH CLINIC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 901 FOREST STREET
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City | SHELBY
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State | MS
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Zip | 38774
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Country | US
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Telephone | 662-398-5004
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1507
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City | CLARKSDALE
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State | MS
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Zip | 38614-1507
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Country | US
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Telephone | 662-398-5004
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. VANELLA CAMPBELL
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Credential |
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Telephone | 662-398-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | MS
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