Provider Demographics
NPI:1346552726
Name:MCGEHEE FAMILY HEALTH CLINIC, P.A.
Entity type:Organization
Organization Name:MCGEHEE FAMILY HEALTH CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:PATE
Authorized Official - Last Name:MCGEHEE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:662-417-1710
Mailing Address - Street 1:100 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5249
Mailing Address - Country:US
Mailing Address - Phone:662-226-0600
Mailing Address - Fax:662-226-0644
Practice Address - Street 1:100 E MONROE ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5249
Practice Address - Country:US
Practice Address - Phone:662-417-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR745671261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115715Medicaid
MSS06937Medicare UPIN