Provider Demographics
NPI:1215276175
Name:DUTCH MEDICAL CLINICS, INC
Entity type:Organization
Organization Name:DUTCH MEDICAL CLINICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-327-5202
Mailing Address - Street 1:PO BOX 2385
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39704-2385
Mailing Address - Country:US
Mailing Address - Phone:662-327-5202
Mailing Address - Fax:662-327-1228
Practice Address - Street 1:3654-B NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702
Practice Address - Country:US
Practice Address - Phone:662-329-1488
Practice Address - Fax:662-329-1486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUTCH MEDICAL CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care