Fondren Medical Clinic

LBN: Fondren Medical Clinic
Fondren Medical Clinic is an health care organization with primary practice located at 4436 N State St Suite A-1, Jackson MS 39206-5334. The organization recently has only one registered license in Ambulatory Health Care Facilities / Primary Care, which is considered as the primary health care specialty. Fondren Medical Clinic can be contacted via phone (769) 257-5339, or through Lane-Fisher, Theresa Leijuan via phone (769) 257-5336.

Contact Information

Primary practice address
4436 N State St Suite A-1 Jackson MS 39206-5334
Phone: (769) 257-5339
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Lane-Fisher, Theresa Leijuan P.H,D,PA
Phone: (769) 257-5336

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Primary Care 261QP2300X

Profile Details

NPI number 1043573199
LBN Legal business name Fondren Medical Clinic
DBA Doing business as
Authorized official Lane-Fisher, Theresa Leijuan P.H,D,PA
Entity Organization
Organization subpart 1 No
Enumeration date Jun 22nd, 2012
Last updated Jun 22nd, 2012 - about 14 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 1043573199 NPPES
Mississippi MEDICAID 00125523

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