MEDICARE: CLARKSDALE HMA 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	207RC0000X	Cardiovascular Disease Physician

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	:	1639104094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKSDALE HMA INC

Provider Business Mailing Address
First Line	:	1970 HOSPITAL DR
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-7202
Country	:	US
Telephone Number	:	662-624-3401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 HOSPITAL DR
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-7202
Country	:	US
Telephone Number	:	662-624-3401
Fax Number	:

Authorized Official
Title or Position	:	SR VP AND GENERAL COUNSEL
Name	:	TIMOTHY PARRY
Credential	:	ESQ
Telephone Number	:	239-598-3167

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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Directions to “CLARKSDALE HMA INC ” Practice Location

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