Provider Demographics
NPI:1699233916
Name:COX HEALTHCARE CLINIC, LLC
Entity type:Organization
Organization Name:COX HEALTHCARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CSQSHUNDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:662-686-5017
Mailing Address - Street 1:404 HUDDLESTON ST
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756-2618
Mailing Address - Country:US
Mailing Address - Phone:662-822-0310
Mailing Address - Fax:
Practice Address - Street 1:365 W REED RD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-6967
Practice Address - Country:US
Practice Address - Phone:662-702-3944
Practice Address - Fax:662-702-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care