=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902826951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENTER MEDICAL CLINIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 03/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 THIRD STREET
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-454-7170
-----------------------------------------------------
Fax | 662-454-7177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 549
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38827-0549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-454-7170
-----------------------------------------------------
Fax | 662-454-7177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEPHEN K SENTER
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 662-454-7170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10171
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------