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General NPI Number Information
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NPI Number | 1922271691
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Entity Type | Organization
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Legal Business Name | JEFFERSON COMPREHENSIVE HEALTH CENTER INC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | ROUTE 1 BOX 266
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City | FAYETTE
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State | MS
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Zip | 39069
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Country | US
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Telephone | 601-786-3475
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Fax | 601-786-9980
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 98
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City | FAYETTE
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State | MS
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Zip | 39069-5515
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Country | US
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Telephone | 601-786-3475
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Fax | 601-786-9980
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Authorized Official
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Title or Position | CEO
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Name | SHIRLEY A. ELLIS
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Credential | MBA
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Telephone | 601-786-3475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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