MEDICARE: THE DOWNTOWN 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	901361	MS

General Provider Information

NPI Number	:	1417481474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DOWNTOWN FAMILY CLINIC, LLC

Provider Business Mailing Address
First Line	:	1462 S COLORADO ST APT 5A
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 WASHINGTON AVE
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-3615
Country	:	US
Telephone Number	:	662-347-6686
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEXIS CROSS
Credential	:	CFNP
Telephone Number	:	662-347-6686

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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