MEDICARE: AARON E HENRY COMMUNITY HEALTH

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1063756716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AARON E HENRY COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	510 HIGHWAY 322
Second Line	:	P O BOX 1216
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-4717
Country	:	US
Telephone Number	:	662-624-4292
Fax Number	:	662-624-4354

Provider Business Practice Location Address
First Line	:	510 HIGHWAY 322
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-4717
Country	:	US
Telephone Number	:	662-624-4292
Fax Number	:	662-624-4354

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	MS. AURELIA JONES-TAYLOR
Credential	:
Telephone Number	:	662-624-4292

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	06/04/2020

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Practice Location Address:

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