Provider Demographics
NPI:1902888316
Name:MCCOMB CHILDREN'S CLINIC, LTD
Entity Type:Organization
Organization Name:MCCOMB CHILDREN'S CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:601-684-7623
Mailing Address - Street 1:300 RAWLS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2852
Mailing Address - Country:US
Mailing Address - Phone:601-684-7623
Mailing Address - Fax:601-684-7247
Practice Address - Street 1:300 RAWLS DR STE 100
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2852
Practice Address - Country:US
Practice Address - Phone:601-684-7623
Practice Address - Fax:601-684-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-19
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09011311Medicaid