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Contact Information

CHILDRENS CLINIC OF CLARKSDALE PA
2245 N STATE STREET
CLARKSDALE, MS38614
 Phone: 662-627-4131
 Fax: 662-627-2702
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for CHILDRENS CLINIC OF CLARKSDALE PA

NPI # 1497834030
LBN Legal business name CHILDRENS CLINIC OF CLARKSDALE PA
Authorized official CAROLE MANGREM - (PARTNER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/03/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
MS License # 07070
MS License # 07191
MS License # R861078
MS Medicaid 09013997
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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