Provider Demographics
NPI:1427098003
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:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
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 1:1203 AVE B
Practice Address - Street 2:SUITE 200
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437
Practice Address - Country:US
Practice Address - Phone:601-477-3550
Practice Address - Fax:601-477-2236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL REGIONAL MED CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS253437261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014135Medicaid
MS253437Medicare Oscar/Certification