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General NPI Number Information
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NPI Number | 1871863233
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE FAMILY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 3040 GOODMAN RD W
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City | HORN LAKE
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State | MS
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Zip | 38637-1189
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Country | US
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Telephone | 662-280-3428
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Fax | 662-280-1736
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Provider Business Mailing Address
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Address Line | 3040 GOODMAN RD W
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City | HORN LAKE
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State | MS
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Zip | 38637-1189
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Country | US
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Telephone | 662-280-3428
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Fax | 662-280-1736
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Authorized Official
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Title or Position | OWNER
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Name | BARRY POLITI
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Credential | M.D.
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Telephone | 662-280-3428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18992
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License Number State | MS
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