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General NPI Number Information
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NPI Number | 1851851042
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Entity Type | Organization
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Legal Business Name | 1ST CARE MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 223 E MAIN ST
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City | SENATOBIA
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State | MS
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Zip | 38668-2123
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Country | US
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Telephone | 662-213-5078
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Fax |
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Provider Business Mailing Address
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Address Line | 291 DOC WOODY RD
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City | COLDWATER
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State | MS
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Zip | 38618-3501
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Country | US
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Telephone | 662-213-5078
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | MR. ANTHONY NEWSON
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Credential | FNP
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Telephone | 662-213-5078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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