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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366440331
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 TAYLOR
Credential	:
Telephone Number	:	662-624-4292

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	06/02/2020

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Directions to “AARON E HENRY COMMUNITY HEALTH ” Practice Location

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