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General NPI Number Information
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NPI Number | 1679652754
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Entity Type | Organization
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Legal Business Name | EMMANUEL RIDGE COMMUNITY HEALTH CLINIC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2073 HIGHWAY 49 S SUITE A
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City | FLORENCE
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State | MS
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Zip | 39073-9422
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Country | US
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Telephone | 601-709-3301
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Fax | 601-709-3308
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Provider Business Mailing Address
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Address Line | 2073 HIGHWAY 49 S SUITE A
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City | FLORENCE
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State | MS
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Zip | 39073-9422
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Country | US
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Telephone | 601-709-3301
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Fax | 601-709-3308
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. BEATRICE A EZEM
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Credential | RN, CM, CLNC
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Telephone | 601-927-9839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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