MEDICARE: SARDIS FAMILY MEDICAL CLINIC, 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1932399276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARDIS FAMILY MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	116 S MAIN ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1721
Country	:	US
Telephone Number	:	662-487-1064
Fax Number	:	662-487-1381

Provider Business Practice Location Address
First Line	:	116 S MAIN ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1721
Country	:	US
Telephone Number	:	662-487-1064
Fax Number	:	662-487-1381

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MS. KIMBERLY FARROW
Credential	:
Telephone Number	:	662-487-1064

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	06/16/2023

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