Basic Information
| Provider Information | |||||||||
| NPI: | 1013207091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST MEDICAL CLINIC - CONVENIENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1151 N STATE ST | ||||||||
| Address2: | SUITE 504 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012924261 | ||||||||
| FaxNumber: | 6012924262 | ||||||||
| Practice Location | |||||||||
| Address1: | 5341 LAKELAND DR | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392326173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019192173 | ||||||||
| FaxNumber: | 6019199723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL CLINIC OFFICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6012924261 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.