Provider Demographics
NPI:1487972568
Name:THE CLINIC AT FARMERS MEDSHOPPE
Entity type:Organization
Organization Name:THE CLINIC AT FARMERS MEDSHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-424-3540
Mailing Address - Street 1:P.O. BOX 669
Mailing Address - Street 2:
Mailing Address - City:FOXWORTH
Mailing Address - State:MS
Mailing Address - Zip Code:39483
Mailing Address - Country:US
Mailing Address - Phone:601-424-3540
Mailing Address - Fax:601-424-3544
Practice Address - Street 1:62 HIGHWAY 587
Practice Address - Street 2:
Practice Address - City:FOXWORTH
Practice Address - State:MS
Practice Address - Zip Code:39483
Practice Address - Country:US
Practice Address - Phone:601-424-3540
Practice Address - Fax:601-424-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QR1300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health