Childrens Clinic Of Clarksdale Pa

LBN: Childrens Clinic Of Clarksdale Pa
Childrens Clinic Of Clarksdale Pa is an health care organization with primary practice located at 2245 N State Street , Clarksdale MS 38614. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as the primary health care specialty. Childrens Clinic Of Clarksdale Pa can be contacted via phone (662) 627-4131, or through Mangrem, Carole L via phone (662) 627-4131.

Contact Information

Primary practice address
2245 N State Street Clarksdale MS 38614
Phone: (662) 627-4131
Fax: (662) 627-2702
Website:
Map and Directions
Authorized official contact:
Name: Mangrem, Carole L Doctor of Medicine (MD)
Phone: (662) 627-4131

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 07191 Mississippi
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 07070 Mississippi
Allopathic & Osteopathic Physicians / Pediatrics 208000000X R861078 Mississippi

Profile Details

NPI number 1497834030
LBN Legal business name Childrens Clinic Of Clarksdale Pa
DBA Doing business as
Authorized official Mangrem, Carole L Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 3rd, 2006
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497834030 NPPES
Mississippi MEDICAID 09013997

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