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General NPI Number Information
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NPI Number | 1992256499
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Entity Type | Organization
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Legal Business Name | SARDIS FAMILY MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 124 S MAIN ST
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City | SARDIS
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State | MS
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Zip | 38666-1721
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Country | US
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Telephone | 662-487-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 124 SOUTH MAIN ST.
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City | SARDIS
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State | MS
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Zip | 38666
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Country | US
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Telephone | 662-487-1064
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI CRAIN
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Credential |
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Telephone | 662-487-1064
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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 | 901574
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License Number State | MS
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