Provider Demographics
NPI:1447031943
Name:MANTACHIE RURAL HEALTH CARE, INC
Entity type:Organization
Organization Name:MANTACHIE RURAL HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:CRABB
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-282-4226
Mailing Address - Street 1:5681 HIGHWAY 363
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-7632
Mailing Address - Country:US
Mailing Address - Phone:662-282-4226
Mailing Address - Fax:
Practice Address - Street 1:1 DORSEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8899
Practice Address - Country:US
Practice Address - Phone:662-282-4226
Practice Address - Fax:662-282-7946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANTACHIE RURAL HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)