Provider Demographics
NPI:1942574363
Name:FAMILY & URGENT CARE CLINIC
Entity type:Organization
Organization Name:FAMILY & URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-280-3428
Mailing Address - Street 1:3040 GOODMAN RD W
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1189
Mailing Address - Country:US
Mailing Address - Phone:662-280-3428
Mailing Address - Fax:662-280-1736
Practice Address - Street 1:3040 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1189
Practice Address - Country:US
Practice Address - Phone:662-280-3428
Practice Address - Fax:662-280-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty