MEDICARE: LENA FAMILY MEDICAL, INC.

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	:	1184120883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENA FAMILY MEDICAL, INC.

Provider Business Mailing Address
First Line	:	1107 GRAND AVENUE
Second Line	:	P.O. BOX 295
City	:	LENA
State	:	MS
Zip	:	39094
Country	:	US
Telephone Number	:	601-654-3433
Fax Number	:	601-654-0117

Provider Business Practice Location Address
First Line	:	1107 GRAND AVENUE
Second Line	:
City	:	LENA
State	:	MS
Zip	:	39094
Country	:	US
Telephone Number	:	601-654-3433
Fax Number	:	601-654-0117

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	REBECCA ANNETTE JOHNSTON
Credential	:	FNP-C
Telephone Number	:	601-654-3433

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	03/04/2021

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