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General NPI Number Information
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NPI Number | 1932436813
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Entity Type | Organization
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Legal Business Name | REGIONAL MEDICAL CLINIC, LLC.
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 4297 HIGHWAY 42
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City | BASSFIELD
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State | MS
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Zip | 39421-4424
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Country | US
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Telephone | 601-943-5060
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Fax | 601-943-5888
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | BASSFIELD
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State | MS
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Zip | 39421-0068
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Country | US
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Telephone | 601-943-5060
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Fax | 601-943-5888
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. ROY DUDLEY EVANS
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Credential | M.D.
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Telephone | 601-943-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 13317
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License Number State | MS
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