Provider Demographics
NPI:1154405413
Name:SOUTH CENTRAL CLINICS, INC
Entity type:Organization
Organization Name:SOUTH CENTRAL CLINICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CLINIC SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:CHANCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-399-6167
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-425-7550
Mailing Address - Fax:601-399-6281
Practice Address - Street 1:1002 JEFFERSON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4350
Practice Address - Country:US
Practice Address - Phone:601-649-7802
Practice Address - Fax:601-428-7841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00186342Medicaid
MS00186342Medicaid