Provider Demographics
NPI:1073971792
Name:CORNER CLINIC URGENT CARE LLC
Entity type:Organization
Organization Name:CORNER CLINIC URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:601-992-0004
Mailing Address - Street 1:225 BANK FIRST DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-6611
Mailing Address - Country:US
Mailing Address - Phone:601-992-0004
Mailing Address - Fax:769-572-7926
Practice Address - Street 1:225 BANK FIRST DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6611
Practice Address - Country:US
Practice Address - Phone:601-992-0004
Practice Address - Fax:769-572-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867447363LF0000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty