LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE; NPI #1053576819

Contact Information

LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE

110 PARK ST
WALNUT GROVE, MS 39189-6526

Phone: 601-267-1400
Fax: 601-253-9464
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Rural	282NR1301X

Indicates primary specialty

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NPI Profile & details for LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE

NPI # 1053576819

LBN Legal business name LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE

Authorized official KRISTI ESTEP - (OFFICE MANAGER)

Entity Organization

Organization subpart ¹ No

Enumeration date 07/22/2008

Last updated 07/22/2008 - About 18 years ago

Identifiers

Medicaid

05874018

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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LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE

Contact Information

Specialty

Rural

NPI Profile & details for LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE

Reviews for LEAKE MEMORIAL MEDICAL CLINIC WALNUT GROVE