| Family Health Care Clinic, Inc. | |
| 
					910 Second Street Prentiss MS 39474  | |
| (601) 792-2078 | |
| (601) 792-8211 | 
| Full Name | Family Health Care Clinic, Inc. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 910 Second Street, Prentiss, Mississippi | 
| Authorized Official Name and Position | Karina Marie Clayton (CHIEF FINANCIAL OFFICER) | 
| Authorized Official Contact | 6018257280 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Family Health Care Clinic, Inc. Po Box 24116 Jackson MS 39225-4116 Ph: (601) 825-7280  | Family Health Care Clinic, Inc. 910 Second Street Prentiss MS 39474 Ph: (601) 792-2078  | 
| NPI Number | 1144246398 | 
|---|---|
| Provider Enumeration Date | 07/14/2006 | 
| Last Update Date | 04/16/2020 | 
| Medicare PECOS PAC ID | 5395656946 | 
|---|---|
| Medicare Enrollment ID | O20080303000381 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1144246398 | NPI | - | NPPES | 
| 09014311 | Medicaid | MS | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary | 
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