JACKSON FREE CLINIC NPI 1851068324

NPI Information

JACKSON FREE CLINIC is a voluntary or charitable in Jackson, MS. JACKSON FREE CLINIC NPI is 1851068324. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Jackson Free Clinic For The Homeless.

The provider's business location address is:

925 MARTIN LUTHER KING JR DR
JACKSON, MS
ZIP 39203-233
Phone: (601) 355-5161

The provider's authorized official is Hali Peterson .
The authorized official title is Chair Of The Board and has the following contact phone number (601) 355-5161.

The CLIA number assigned to this NPI record is 25D0995019 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/24/2021 and was last updated on 6/21/2022.

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:

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