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General NPI Number Information
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NPI Number | 1942536552
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Entity Type | Organization
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Legal Business Name | DURANT PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 22741 BOWLING GREEN RD
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City | LEXINGTON
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State | MS
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Zip | 39095
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Country | US
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Telephone | 662-834-1961
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Fax | 662-834-1962
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Provider Business Mailing Address
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Address Line | 22741 HWY 12 BOWLING GREEN RD
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City | LEXINGTON
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State | MS
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Zip | 39095
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Country | US
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Telephone | 662-834-1961
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Fax | 662-834-1962
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SHELIA ANN SNOW
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Credential |
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Telephone | 662-834-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 14192
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License Number State | MS
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