Provider Demographics
NPI:1992256499
Name:SARDIS FAMILY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:SARDIS FAMILY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-487-1064
Mailing Address - Street 1:124 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SARDIS
Mailing Address - State:MS
Mailing Address - Zip Code:38666
Mailing Address - Country:US
Mailing Address - Phone:662-487-1064
Mailing Address - Fax:
Practice Address - Street 1:124 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-1721
Practice Address - Country:US
Practice Address - Phone:662-487-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901574261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care