MEDICARE: COMMUNITY 1ST FAMILY CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1043189335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY 1ST FAMILY CLINIC LLC

Provider Business Mailing Address
First Line	:	309 MAIN ST STE A
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-6197
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 MAIN ST STE A
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-6197
Country	:	US
Telephone Number	:	601-641-4070
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	REGINA LEE
Credential	:	NP
Telephone Number	:	601-641-4070

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	12/12/2025

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