WATER VALLEY MEDICAL CLINIC LLC NPI 1487605499

NPI Information

  • NPI: 1487605499
  • Provider Name: WATER VALLEY MEDICAL CLINIC LLC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 25D2101534
  • Address: 712 S MAIN ST
    WATER VALLEY, MS
    ZIP 38965
  • Phone: (662) 473-1140

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NPI Details

WATER VALLEY MEDICAL CLINIC LLC is a clinic center in Water Valley, MS. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). WATER VALLEY MEDICAL CLINIC LLC NPI is 1487605499. The provider is registered as an organization entity type.

The provider's business location address is:

712 S MAIN ST
WATER VALLEY, MS
ZIP 38965-334
Phone: (662) 473-1140
Fax: (662) 473-1138

The provider's authorized official is Bojan Milicevic .
The authorized official title is Owner and has the following contact phone number (662) 473-1140.

The CLIA number assigned to this NPI record is 25D2101534 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/15/2006 and was last updated on 8/22/2020.

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
1261Q00000XClinic/CenterYes

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: 3/30/2025

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