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NPI Code Detail

MEDICARE: FONDREN HEALTH CLINIC

MEDICARE: FONDREN HEALTH CLINIC
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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1235508623
Entity Type Code : Organization
Provider Name (Legal Business Name) : FONDREN HEALTH CLINIC
Provider Business Mailing Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-624-3352
Fax Number :
Provider Business Practice Location Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-624-3352
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MRS. YUREE COX
Credential :
Telephone Number : 601-624-3352
Provider Enumeration Date : 09/16/2015
Last Update Date : 09/16/2015

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Directions to “FONDREN HEALTH CLINIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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