EXTENDED CARE CLINICAL SERVICES LLC NPI 1134741945

NPI Information

NPI: 1134741945
Provider Name: EXTENDED CARE CLINICAL SERVICES LLC

Doing Business As: EXTENDED CARE CLINICAL SERVICES

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
724 N JACKSON ST
BROOKHAVEN, MS
ZIP 39601
Phone: (601) 412-4503
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EXTENDED CARE CLINICAL SERVICES LLC is a primary care clinic center in Brookhaven, MS. EXTENDED CARE CLINICAL SERVICES LLC NPI is 1134741945. The provider is registered as an organization entity type.
The provider Is Doing Business As Extended Care Clinical Services.

The provider's business location address is:

724 N JACKSON ST
BROOKHAVEN, MS
ZIP 39601-460
Phone: (601) 412-4503

The provider's authorized official is Mallory Mowdy .
The authorized official title is President and has the following contact phone number (601) 730-0602.

The CLIA number assigned to this NPI record is 25D2249501 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/14/2020 and was last updated on 9/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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