Provider Demographics
NPI:1528273315
Name:CUMMINGS HEALTH CARE CENTER
Entity type:Organization
Organization Name:CUMMINGS HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-627-4442
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:536 CHOCTAW STREET
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-8410
Mailing Address - Country:US
Mailing Address - Phone:662-627-4442
Mailing Address - Fax:662-627-9665
Practice Address - Street 1:536 S CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4800
Practice Address - Country:US
Practice Address - Phone:662-627-4442
Practice Address - Fax:662-627-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12250261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care