North Delta Medicine Clinic P A

LBN: North Delta Medicine Clinic P A
North Delta Medicine Clinic P A is an health care organization with primary practice located at 705 N State St , Clarksdale MS 38614-6519. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as the primary health care specialty. North Delta Medicine Clinic P A can be contacted via phone (662) 621-2192, or through Kellough, Kenneth Wayne via phone (662) 621-2192.

Contact Information

Primary practice address
705 N State St Clarksdale MS 38614-6519
Phone: (662) 621-2192
Fax: (662) 621-2314
Website:
Map and Directions
Authorized official contact:
Name: Kellough, Kenneth Wayne Doctor of Medicine (MD)
Phone: (662) 621-2192

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 16776 Mississippi

Profile Details

NPI number 1780778571
LBN Legal business name North Delta Medicine Clinic P A
DBA Doing business as
Authorized official Kellough, Kenneth Wayne Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 3rd, 2006
Last updated Dec 3rd, 2009 - about 17 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 1780778571 NPPES
Mississippi MEDICAID 01188776

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