Provider Demographics
NPI:1306966502
Name:COURT SQUARE RURAL HEALTH CLINIC
Entity type:Organization
Organization Name:COURT SQUARE RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMLLBERLY
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:662-375-7717
Mailing Address - Street 1:406 EAST COURT STREET
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:MS
Mailing Address - Zip Code:38957
Mailing Address - Country:US
Mailing Address - Phone:662-375-7717
Mailing Address - Fax:662-375-7719
Practice Address - Street 1:406 EAST COURT ST.
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:MS
Practice Address - Zip Code:38957
Practice Address - Country:US
Practice Address - Phone:662-375-7717
Practice Address - Fax:662-375-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty