=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841616265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AARON E HENRY COMMUNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2014
-----------------------------------------------------
Last Update Date | 06/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 643 W SERVICE DR
-----------------------------------------------------
City | COLDWATER
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38618-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-624-4292
-----------------------------------------------------
Fax | 662-624-4354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 HIGHWAY 322 P O BOX 1216
-----------------------------------------------------
City | CLARKSDALE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38614-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-624-2504
-----------------------------------------------------
Fax | 662-624-4354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. AURELIA JONES-TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-624-4292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------