Provider Demographics
NPI:1649681511
Name:WHEELER CLINIC INC.
Entity type:Organization
Organization Name:WHEELER CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLPN
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-365-0200
Mailing Address - Street 1:618 COUNTY ROAD 5031
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-9410
Mailing Address - Country:US
Mailing Address - Phone:662-365-0200
Mailing Address - Fax:662-365-0199
Practice Address - Street 1:618 COUNTY ROAD 5031
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-9410
Practice Address - Country:US
Practice Address - Phone:662-365-0200
Practice Address - Fax:662-365-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center