Provider Demographics
NPI:1023885803
Name:MEDIQUIK CLINIC LLC
Entity type:Organization
Organization Name:MEDIQUIK CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-237-0404
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MS
Mailing Address - Zip Code:38917-0094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 COUNTY ROAD 74
Practice Address - Street 2:
Practice Address - City:MC CARLEY
Practice Address - State:MS
Practice Address - Zip Code:38943-6820
Practice Address - Country:US
Practice Address - Phone:662-237-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty